This study employed a descriptive cross-sectional design and was conducted at the Psychiatric Outpatient Addiction Clinic of Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. AKTH is a federal tertiary referral facility located in northern Nigeria, offering specialized care, medical education, and research services across a broad range of disciplines.

The addiction clinic, situated within the Department of Psychiatry, provides weekly outpatient services, with an average attendance of approximately 20 patients per clinic day. It is staffed by a multidisciplinary team, including consultant psychiatrists, resident doctors, addiction specialists, clinical psychologists, psychiatric nurses, and social workers. Services are evidence-based and include pharmacotherapy, individual and group psychotherapy, family interventions, motivational interviewing, and relapse prevention strategies. The clinic operates within a structured outpatient framework, delivering comprehensive care to individuals with substance use disorders (SUDs).

The study population consisted of adult patients (aged 18 years and above) attending the outpatient addiction clinic at AKTH over a three-month period. A census sampling method was used, whereby all eligible and consenting patients within the specified timeframe were included, resulting in a sample of 201 participants. This approach enhanced representativeness by including new and follow-up attendees. The multiple regression models examined seven predictors of perceived recovery and satisfaction: age, education, gender, marital status, employment, ASI domains, and urine toxicology. A power analysis using G*Power confirmed that N = 201 exceeds the minimum of 103 required for 80% power to detect a medium effect size (f² = 0.15) with seven predictors at α = 0.05. The three-month period captured typical clinic attendance patterns, ensuring a robust sample.

Inclusion criteria were: (a) current enrollment in treatment at the addiction clinic, (b) ability to provide informed consent, and (c) fluency in English or Hausa. Patients were excluded if they had severe cognitive impairment or acute psychiatric instability that could preclude meaningful participation. The census approach was selected to capture a broad range of patient experiences, including differences in demographic characteristics, substance use history, and levels of treatment engagement.

Data were collected using a structured questionnaire comprising both standardized and study-specific tools. The instruments included:

Additionally, the questionnaire captured participants’ socio-demographic information, including age, gender, marital status, educational attainment, employment status, and frequency of clinic attendance.

Eligible participants were approached during routine clinic visits. After obtaining written informed consent, participants completed the questionnaires in a private space within the clinic. The self-administered format was supported by trained research assistants who provided clarification when required but did not influence participants’ responses. Each questionnaire required approximately 20 to 30 minutes to complete.

To ensure cultural and linguistic appropriateness, Hausa-translated versions of the TEAS and CATS were used where necessary, employing forward- and back-translation procedures in line with best practices for cross-cultural adaptation.

All quantitative analyses were conducted using IBM SPSS Statistics (Version 25). Descriptive statistics (e.g., frequencies, percentages, means, and standard deviations) were used to summarize participants’ socio-demographic characteristics and baseline scores from structured measures, including the Treatment Effectiveness Assessment Scale (TEAS), Clinical Assessment Tool for Substance Use (CATS), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and the Addiction Severity Index (ASI).

Bivariate analyses (e.g., Chi-square tests, independent samples t-tests, and one-way ANOVAs) were used to assess associations between demographic and clinical variables and treatment outcomes. Multivariate analyses were subsequently performed using hierarchical linear regression and multivariate analysis of variance (MANOVA) to identify independent predictors of perceived recovery and treatment satisfaction. Pearson’s r correlations were used to examine relationships between continuous variables, such as severity of substance use and indicators of recovery. A significance level of p < 0.05 was applied across all inferential tests.

In addition to quantitative procedures, qualitative responses collected via the TEAS open-ended sections were systematically analyzed using thematic analysis [14] . Responses were coded inductively by multiple independent raters, followed by a consensus review to develop thematic categories. Frequencies of theme occurrence were then quantified to provide a complementary interpretation of participant experiences, including recovery motivation, health perceptions, and social reintegration.

Ethical approval was obtained from the Research and Ethics Committee of Aminu Kano Teaching Hospital (AKTH). All participants received an information sheet detailing the purpose of the study and their rights. Written informed consent was obtained prior to participation. To maintain confidentiality, all data were anonymized, and research materials were stored securely. Participants were informed that their involvement was voluntary and that they could withdraw at any time without any effect on their treatment.

A total of 201 participants were included, predominantly single (67.2%), male (79.6%), urban-dwelling (76.1%) individuals of Hausa ethnicity (70.6%), aged 20 - 29 years (60.7%), with secondary (54.7%) or tertiary (33.3%) education ( Table 1 ). These characteristics provide context for subsequent analyses of treatment effectiveness and satisfaction outcomes.

Education (none/primary, secondary, and tertiary) and employment status (employed full-time, employed part-time, unemployed, student, and retired) were significant predictors of both the Treatment Effectiveness Assessment Scale (TEAS) and Client Assessment of Treatment Scale (CATS) outcomes, with higher education (β = 0.35, p = 0.002 for TEAS; β = 0.41, p = 0.001 for CATS) and employment (β = 0.29, p = 0.014 for TEAS; β = 0.34, p = 0.006 for CATS) linked to better recovery and satisfaction ( Table 2 ). Age, gender, and marital status

Note: Standardized beta coefficients (β) and p-values are from multiple linear regression analyses. Adjusted R², F-statistic, and model p-values reflect multivariate models with education and employment as predictors.

(single, married, divorced, widowed, or separated) showed no significant associations (p > 0.05). Multivariate models confirmed that education and employment explained 43% of the variance in TEAS scores (Adjusted R² = 0.43, F (2, 20) = 8.71, p = 0.001) and 49% in CATS scores (Adjusted R² = 0.49, F (2, 20) = 9.94, p < 0.001). Clinical predictors, including ASI psychiatric domain scores (β = −0.33, p < 0.001 for TEAS; β = −0.30, p < 0.001 for CATS) and urine toxicology positivity (β = −0.27, p < 0.01 for TEAS; β = −0.28, p = 0.004 for CATS), were also robust predictors, accounting for over 50% of the variance in both outcomes.

Note: Negative correlations indicate that higher variable scores are associated with lower TEAS (Treatment Effectiveness Assessment Scale) or CATS (Client Assessment of Treatment Scale) scores.

Higher substance use severity, as measured by ASSIST scores (M = 24.74, SD = 3.77), was negatively correlated with TEAS recovery scores (r = −0.49, p = 0.015), as was urine toxicology positivity (r = −0.37, p = 0.049; Table 3 ). Similarly, urine toxicology positivity (r = −0.39, p = 0.008), ASI psychiatric domain scores (r = −0.48, p < 0.01), and ASI medical domain scores (r = −0.32, p = 0.021) were negatively correlated with CATS satisfaction scores. These findings ( Table 3 ) indicate that ongoing substance use and comorbid psychiatric and medical issues undermine perceived recovery and satisfaction.

Note: Negative correlations indicate that greater severity is associated with lower satisfaction on the Client Assessment of Treatment Scale (CATS).

This table summarizes correlations between ASI domain scores and CATS satisfaction scores. The strongest negative correlations were observed with the psychiatric and employment domains. Addiction Severity Index (ASI) domain scores revealed significant negative correlations with CATS satisfaction scores, particularly for psychiatric (r = −0.51, p = 0.009) and employment (r = −0.38, p = 0.041) domains, with weaker correlations for family/social (r = −0.30, p = 0.076), medical (r = −0.18, p = 0.167), and legal (r = −0.14, p = 0.262) domains ( Table 4 ). These results highlight psychiatric and employment challenges as the strongest barriers to perceived treatment satisfaction.

Note: 1 cell (25.0%) had an expected count less than 5; the minimum expected count was 1.20.

A total of 201 participants were included in the analysis. Table 5 presents the distribution of respondents by gender and their reported use of injectables. Among males, 5.0% reported using injectables, while 9.1% of females did. However, Pearson’s chi-square test revealed no statistically significant association between gender and the use of injectables, χ² (1, N = 201) = 0.625, p = 0.429. Similarly, Fisher’s Exact Test yielded a non-significant result (p = 0.344), confirming the lack of a statistically meaningful relationship, despite a slightly higher prevalence among females.

Table 6 summarizes the mean scores of TEAS and CATS scores. No significant association was found between gender and injectable drug use, with 5.0% of males and 9.1% of females reporting injectable use (χ² (1, N = 201) = 0.625, p = 0.429; Fisher’s Exact Test, p = 0.344). Education level significantly influenced outcomes,

Note: TEAS = Treatment Effectiveness Assessment Scale; CATS = Client Assessment of Treatment Scale. MANOVA for education: Wilks’ Λ = 0.78, F (4, 136) = 3.95, p = 0.005. Two-way ANOVA for gender × education interaction on TEAS: F (2, 132) = 4.67, p = 0.011.

with tertiary education linked to the highest TEAS (M = 41.5) and CATS (M = 44.3) scores, followed by secondary (TEAS: M = 35.7; CATS: M = 37.1) and no formal education (TEAS: M = 29.2; CATS: M = 30.6). A MANOVA confirmed a significant multivariate effect of education (Wilks’ Λ = 0.78, F (4, 136) = 3.95, p = 0.005). A significant gender-education interaction was observed for TEAS scores (F (2, 132) = 4.67, p = 0.011), with males with tertiary education reporting the highest scores (M = 45.7) and females with no formal education the lowest (M = 25.3).

This study investigated the socio-demographic, clinical, and psychosocial predictors of perceived recovery and treatment satisfaction among individuals undergoing substance use disorder (SUD) treatment in Kano, Nigeria. Using validated scales—the Treatment Effectiveness Assessment Scale (TEAS) and the Client Assessment of Treatment Scale (CATS)—we found that education level, employment status, substance use severity, and psychiatric comorbidity were consistent and significant correlates of both recovery and satisfaction. These findings contribute to the growing literature on context-specific predictors of substance use treatment outcomes, especially within sub-Saharan Africa.

Educational attainment and income emerged as strong predictors of positive treatment outcomes. This finding is supported by previous research showing that individuals with higher levels of education are more likely to possess the health literacy and adaptive coping skills necessary to engage meaningfully in recovery processes [15] . Moreover, socio-economic status—including stable employment and higher income—has been found to enhance access to health resources and supportive networks, thereby improving treatment adherence and overall satisfaction [16] .

Age differences were also evident: older adults reported greater satisfaction and perceived recovery than younger participants, likely due to more stable social roles and reduced exposure to peer and environmental risk factors [17] [18] . Meanwhile, younger individuals may experience more external barriers and ongoing life transitions that limit sustained recovery. Gender differences emerged as well: males reported higher satisfaction and recovery, while females—who often face compounded stigma, childcare concerns, and trauma exposure—encounter disproportionate barriers that can limit treatment engagement and perceived benefit [19] [20] .

Substance use severity was strongly negatively correlated with both TEAS and CATS scores. Higher ASSIST scores and poly-substance use were particularly associated with lower perceived recovery. These findings are consistent with research suggesting that individuals engaging in multiple substance use patterns exhibit more complex and treatment-resistant profiles [7] [12] .

Notably, urine toxicology, an objective indicator of ongoing substance use, served as a significant predictor of both poorer perceived recovery (TEAS) and lower treatment satisfaction (CATS). In a retrospective cohort study involving outpatient addiction assessments, Kolla et al. (2019) found that positive urine drug tests revealed undisclosed substance use and led clinicians to modify diagnoses or treatment plans, indicating that ongoing use undermines therapeutic progress [21] . Similarly, initial positive toxicology screenings among cocaine-dependent patients were strong predictors of treatment attrition [22] . These findings align with broader research showing that active substance use during treatment, as identified by urine testing, correlates with reduced engagement, relapse, and lower satisfaction with care [23] .

The ASI domains revealed critical insights, with over 59% of participants showing issues in at least one domain, and the psychiatric and family/social domains being the most common. These observations are consistent with research indicating that unresolved psychiatric symptoms, such as depression and anxiety, can significantly compromise treatment motivation and outcomes [24] . Additionally, family and social dysfunction have been shown to impair recovery when not addressed during treatment [25] .

Psychiatric distress was the strongest predictor of both reduced recovery and satisfaction in this study, reinforcing the literature that calls for integrated models of care for co-occurring disorders [26] [27] . In resource-limited settings like Nigeria, where mental health services are often inaccessible or stigmatized, untreated psychiatric conditions may exacerbate substance use and impair therapeutic relationships.

Clinic engagement, as measured by frequency of visits, was positively associated with both satisfaction and recovery. This supports previous findings that regular attendance facilitates stronger therapeutic alliances, consistency in psychosocial interventions, and improved treatment outcomes [28] [29] . Regular engagement may also foster a sense of accountability and reinforce abstinence-based behaviors through continued social reinforcement.

Perceived recovery in the domain of community reintegration was influenced by marital status, income, and employment. This aligns with the social model of recovery, which emphasizes the importance of restoring individuals to meaningful social roles, such as employment and family life, as a key component of sustained recovery [29] [30] . Clients with more stable social and economic roles may have perceived greater benefits from treatment, consistent with societal expectations surrounding productivity and reintegration [31] .

Perceived respect—an essential aspect of treatment satisfaction measured by the CATS—was also influenced by gender and education. Male participants and those with tertiary education reported higher levels of respect from treatment providers. This may reflect either actual differences in provider attitudes or variations in patient expectations and communication styles based on education and gender [32] . Supporting this, research shows that patients who are male or more educated often receive more personalized, respectful care [33] .

While the interaction between education and recovery outcomes did not reach statistical significance, the observed pattern aligns with existing evidence suggesting that educational empowerment functions as a protective factor against the detrimental effects of substance use. Several studies have emphasized that higher educational attainment is associated with lower risk of substance use and improved long-term outcomes [34] . Educational involvement not only equips individuals with cognitive and decision-making skills but also enhances self-efficacy, resilience, and social integration, which are critical to both prevention and recovery [35] . For instance, empowerment-based educational interventions among adolescents in Nigeria resulted in significant reductions in substance use and improvements in self-esteem and resilience [36] . Similarly, participation in adult education programs during addiction recovery has been linked to greater psychological well-being and identity reconstruction, both of which reinforce abstinence and relapse prevention [35] . Thus, despite the lack of a statistically significant interaction in this study, the consistent trend observed supports the growing body of literature highlighting the role of education as a buffer against substance use harm.

The findings of this study have several important implications for policy and practice:

The qualitative responses provided additional insight into clients’ perceptions of treatment and recovery. A substantial proportion highlighted the role of treatment and clinical support, followed closely by personal motivation and abstinence. Themes of improved health and structural constraints also emerged, alongside challenges such as ongoing struggles, ambivalence, or social isolation. Notably, some participants framed their experiences through spirituality, family support, or prior responsibility, offering a broader lens on personal change. These themes reinforce the quantitative findings by contextualizing recovery as both a clinical process and a deeply personal, social journey. Future analyses will further explore these perspectives using detailed narrative methods.