When care becomes control: Young people's experiences of family-mediated drug treatment in Egypt, a MENA context.

BACKGROUND: Family involvement can make drug treatment possible, yet young people may also experience that involvement as pressure or loss of control. Evidence on these dynamics in the Middle East and North Africa remains limited. This study examined how young people in Egypt experienced family involvement in treatment and how providers responded when family support conflicted with young people's autonomy. METHODS: This interpretivist study drew on interviews with 20 young people aged 18-30 years with current or recent treatment experience and 12 healthcare providers in Cairo and Giza. The paper reports a focused analysis from a broader qualitative dataset. Reflexive thematic analysis was conducted in the original language of each transcript, with family systems theory used during later interpretation as a sensitising lens. FINDINGS: Four themes were developed. In "The Family as Gatekeeper," relatives enabled access to treatment but could also determine entry and continuation. "Love and Surveillance" described monitoring that arose from concern yet reduced privacy. "Speaking for Us in There" showed how family authority could shape clinical conversations. "Getting Better for Them, Not for Me" described tension between young people's own recovery needs and family expectations for visible improvement. CONCLUSION: The effect of family involvement depended on how treatment decisions were made. Young people engaged more openly when they had private clinical space, meaningful consent, and a clear role in defining recovery goals. Egyptian drug-treatment services should set explicit procedures for family involvement and confidentiality while recognising that many young adults rely on relatives for practical support.