Social Conditions Shaping Youth Engagement with Drug Treatment: Perspectives of Young People and Healthcare Providers in Egypt, a MENA Context.

BACKGROUND: Young people's engagement with drug treatment in Egypt occurs within social conditions shaped by stigma, family expectations, religion, economic precarity, and a punitive policy environment. Evidence from Middle East and North Africa (MENA) settings remains limited. This study explored how these conditions shape treatment engagement from the perspectives of young people and healthcare providers. METHODS: We conducted an interpretivist qualitative study involving semi-structured interviews with 20 young people aged 18-30 years who were currently engaged with or had recently completed drug treatment and 12 healthcare providers in Cairo and Giza. Interviews were conducted between January and June 2024 and analysed using reflexive thematic analysis. RESULTS: Four interconnected themes were generated. "Caught Between Two Worlds" described religion and family as both resources for recovery and potential barriers to care, with particularly high disclosure costs for young women. "Between Shame and Silence" showed how stigma and family honour delayed help-seeking. "We Use to Cope" linked substance use to unemployment, precarious work, violence, trauma, and limited psychosocial support. "The System Doesn't Understand Us" captured biomedical treatment models that overlooked social needs and constrained youth agency; nine of 20 young participants entered treatment through family or legal instigation. CONCLUSION: Treatment engagement in Egypt is produced through relational, structural, and institutional conditions, not individual motivation alone. Youth-centred, trauma-informed and socially responsive services should integrate psychosocial and vocational support, non-coercive family engagement, anti-stigma approaches, and accessible harm reduction.