Substance use burden sits well below the global average across 22 Arab countries

Substance use disorders are less common across the Arab world than globally, but the gap is not uniform and it is widest for alcohol — findings from a secondary analysis of Global Burden of Disease Study 2023 data covering all 22 Arab League member states, published in The Lancet Regional Health – Eastern Mediterranean on 8 October 2026 [s1].

In 2023 the regional age-standardised prevalence of substance use disorders was 0.78% (median 95% uncertainty interval 0.66–0.89), roughly 63% below the GBD 2023 global estimate of 2.10% [s1]. That is the paper's central number, and it fits a long-standing expectation: sociocultural norms, legal restrictions and, in several countries, religious prohibition press reported substance use below the global mean.

How the comparison was built

The authors analysed GBD 2023 age-standardised estimates of prevalence, disability-adjusted life years and mortality for substance use disorders and seven substance-specific categories, across the 22 Arab League states, by sex, from 2019 to 2023 [s1]. Rather than population-weighting, they summarised the region as the unweighted across-country median, and expressed each value as the percentage by which it fell above or below the GBD 2023 global point estimate [s1]. The study received no funding [s1].

The authors are explicit that this is the first analysis to run every GBD substance use category across all 22 states by sex and disability burden against an explicit global benchmark [s1]. They are equally explicit about the limitation that undercuts any such comparison: the estimates depend on the quality of the primary data each country feeds into GBD, which varies widely, and low reported prevalence can reflect weak surveillance as much as genuinely low use [s1].

Where the region diverges — and where it does not

Alcohol use disorder showed the largest divergence from the global picture, at 0.35% (0.26–0.44), 76% below the global estimate [s1]. That is the expected result and the clearest signal of the region's legal and cultural environment.

Opioid use disorder was the outlier in the other direction. At 0.19% (0.15–0.24) it sat only 11% below the global estimate — far closer to the world average than alcohol — and in the United Arab Emirates it exceeded the global benchmark outright [s1]. Four countries — Libya, the United Arab Emirates, Morocco and Algeria — exceeded the global opioid DALY rate, meaning opioids cost them more healthy life than opioids cost the world on average [s1]. In a region where overall substance burden runs low, opioids are the category that does not follow the pattern.

The sex reversal

The most striking finding is about who is affected. Female opioid use disorder prevalence exceeded male prevalence in 19 of the 22 countries [s1]. That inverts the usual global pattern, in which men dominate almost every substance category, and the authors flag it as a reason to disaggregate reporting by sex rather than assume the male-skewed global profile applies locally. The paper does not settle the mechanism, but the candidate explanations — prescription patterns, treatment-seeking differences, and under-ascertainment of illicit use among men — all point to the same practical need for sex-specific data.

What the study can and cannot say

This is a modelling comparison, not a survey. It describes how the region's estimated burden sits relative to a global benchmark in a single snapshot year, with trends traced back only to 2019. It does not establish why a given country's figure is high or low, and it cannot distinguish a country with genuinely low use from one with genuinely poor measurement. The narrow 2019–2023 window also limits what can be said about trajectory.

What to watch

The authors' recommendations follow directly from the numbers: country-specific planning rather than regional averages, sex-disaggregated reporting to capture the opioid reversal, targeted opioid agonist therapy in the countries exceeding global DALY rates, and stronger primary surveillance to firm up the estimates themselves [s1]. The figure worth tracking is the opioid DALY rate in Libya, the UAE, Morocco and Algeria — whether it stabilises or keeps climbing will say more about the region's trajectory than the reassuringly low headline prevalence does.

Sources

• Prevalence, sex differences, disability burden, and temporal trends of substance use disorders across twenty-two Arab countries, 2019–2023: a secondary analysis of the Global Burden of Disease Study 2023 — The Lancet Regional Health – Eastern Mediterranean, 8 October 2026