Rehabilitation Program for Improving Agitation Behavior Among Patients with Substance Use Disorder: A Quasi-experimental Study

Abstract

Background: Substance use disorder (SUD) is a major global health concern, often associated with agitation behaviours that complicate treatment and worsen outcomes. While pharmacological management is common, evidence on structured, non-pharmacological rehabilitation programs to address agitation in SUD remains limited. Methods: A quasi-experimental single-group pretest-posttest design was conducted among 50 male patients with SUD at an outpatient psychiatric clinic in Egypt (March - September 2024). Participants completed a 9-session rehabilitation program integrating anger management, cognitive restructuring, and problem-solving strategies. Agitation severity and substance misuse were measured using the validated Agitated Behavior Scale (ABS) and the Drug Abuse Screening Test (DAST-10), with steps taken to minimize self-report bias. Results: Participation in the rehabilitation program was associated with a significant reduction in agitation severity (P < 0.001, Cohen's d = 1.10) and substance misuse (P < 0.001, Cohen's d = 1.96). A subgroup analysis revealed that patients with high baseline agitation showed a large, clinically meaningful improvement, with 50% achieving a ≥ 50% reduction in symptoms [number needed to treat (NNT) ≈ 2.5]. Sociodemographic characteristics, particularly older age, were significant predictors of higher post-intervention agitation in adjusted analyses. Patients who were younger, unemployed, with lower education, and rural residence exhibited higher baseline agitation. Conclusions: This study provides preliminary evidence for the potential effectiveness of a structured rehabilitation program in reducing agitation and substance use among male patients with SUD, with analyses suggesting particularly strong effects for those with severe baseline agitation. Sociodemographic characteristics influenced outcomes, underscoring the need for tailored approaches. Future randomized controlled trials (RCTs) including control groups and more diverse populations are recommended to confirm efficacy and explore long-term effects.