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Despite cultural, religious and legal constraints, alcohol and drug abuse is rising in the United Arab Emirates (UAE). Therefore, we aim to produce a scoping review to summarise available scientific literature on alcohol and substance dependence (ASD) in all ethnic and religious groups in the UAE to inform future scientific inquiries.
Social work faculty from the UAE University will conduct the scoping review between March 2023 and February 2024. Drawing on the participants, concept, context (PCC) framework, the following review question was developed: What can be learnt from a review of scientific literature on alcohol and substance abuse in all ethnic and religious groups in the UAE? The scientific literature on ASD in the UAE published between 1971 and January 2023, in either English or Arabic, will be considered, including all ethnic, religious and age groups. Grey literature, such as postgraduate dissertations and conference proceedings, will also be considered. Eight English and two Arabic databases and print copies of literature sources in university libraries will be included. EndNote and Covidence software will be used for deduplication, screening and data extraction. Screening and reviewing search results will involve two English-speaking and two Arabic-speaking team members who will work independently. A third reviewer will resolve conflicts. The inter-rater reliability data from the title and abstract screening stage will be exported, and Cohen’s kappa coefficient will be calculated. Data charting informed by the Covidence data extraction tool 2.0 will occur after pilot testing, followed by qualitative content analysis. Reporting of the findings will align with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews tool.
Ethical approval is not required for this study because this is a scoping review of published studies and grey literature. Findings will be disseminated via peer-reviewed journal publications, scientific conferences and a policy brief.
Keywords: Substance misuse, SOCIAL MEDICINE, PUBLIC HEALTHA scoping review of the scientific literature on alcohol and substance dependence across all ethnic and religious groups in the United Arab Emirates since 1971 will be produced.
The review will include paper copies of scientific literature published in the 1970s and 1980s that are unavailable online.
A diverse team of English and Arabic-speaking faculty with a background in Social work will conduct the review.
There will be no formal assessment of the literature sources.Alcohol and drug abuse is a centuries-old escalating global issue linked to various adverse health and social consequences for individuals, families and communities. 1 In response, target 3.5, one of the United Nations’ 17 Sustainable Development Goals (SDGs) adopted in 2015, aims to ‘strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful alcohol use’. 2 3 While various terms have been used in scientific literature, alcohol and substance dependence (ASD) will be used throughout this review protocol. Decades of studies have accumulated evidence that adverse childhood experiences, comorbidities such as anxiety, mood disorders and other mental health difficulties, contribute to the development of ASD. 4 5 Researchers found a worldwide rise in alcohol and other substance abuse during COVID-19, 6 with deteriorating mental health being a major contributing factor. 6
Research over the years has demonstrated that despite cultural, religious and legal constraints, ASD is on the rise among Muslim Arabs in Islamic nations such as Syria, 7 Jordan and Palestine, 8 9 Saudi Arabia, 10–13 and Kuwait. 14 It is no different in the Islamic nation of the United Arab Emirates (UAE) in the Arabian Gulf, a signatory to the 17 SDGs and part of the Gulf Cooperation Council (GCC). The GCC comprises six Islamic countries: Saudi Arabia, Qatar, Kuwait, Bahrain, Oman and UAE. A 2009 systematic review identified 60 studies published between 1975 and 2007 that reported on alcohol and other substance abuse addictions among Arab Muslims living in GCC countries. The review comprised seven studies conducted in the UAE between 1994 and 2001. These seven studies examined sociodemographic variables, community samples and legal issues associated with ASD. 15 This review, however, has two significant limitations. First, it excluded potential studies on the ASD of other ethnic and religious groups who work and live in the UAE. Second, ASD research published in English and Arabic in the UAE between the 1980s and early 1990s was excluded. 16
There has been increased attention in the literature investigating ASD among UAE citizens and expats in the UAE over the last three decades. Some scholars explored the cultural elements and treatment delivery, 17 while others focused their studies on the estimates of the economic implications of addiction in the UAE. 18 Alhyas et al aimed their studies at youth. They attempted to gain a deeper understanding of the attitudes and perceptions of adolescents in the UAE regarding substance dependence and to identify factors that, in their view, may influence the risk of substance use and suggested possible interventions. 19 Other scholars described UAE substance abuse patterns; 20 characteristics of misusers; 21 recovery patterns 22 and treatment options. 17 Studies conducted by the National Rehabilitation Centre (NRC) in the UAE examined the drug trend information within a substance-using patient population in the UAE to improve knowledge of the nature, severity and context of ASD in the UAE. 23–25 Recent conference proceedings addressing ASD in the UAE reported on the demographic profile of alcohol and substance abuse in the UAE. 26
The UAE is an Islamic country in Western Asia, located in the Middle East and came into existence in 1971 as a federation of seven Emirates, namely Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al Quwain and Fujairah; and Ras Al Khaimah. The Federal Supreme Council is the highest legislative and executive body, consisting of seven members (one for each Emirate). However, some powers are kept with the individual emirates. The population increased dramatically, from 344 512 in 1971 to 9.4 million in 2022. Over 88% of the population are expats who work and live in the UAE and come from more than 200 different countries. 26 27
Since the establishment of the UAE in 1971, the economic and social landscape has shifted significantly. Citizens moved from a nomadic and isolated life into a luxurious lifestyle in urban areas and may have been influenced by the values and traditions of the large expat community. 16 Furthermore, the UAE has emerged as a major tourist hotspot, and its strategic location makes it a significant transhipment point for narcotics like heroin, cocaine, methamphetamine and cannabis. 28 As an Islamic country, the UAE operates under Sharia law. Sharia law is based on what the Qur’an says, so it is against the law for Muslims to own, sell, or drink alcohol or any other illegal substances. Therefore, alcohol consumption is forbidden by Islam and local law in the UAE. However, the UAE’s growing expat population and its reputation as a tourist hotspot may have increased pressure for the country to liberalise its alcohol policies. 28 Before 2020, expats had to hold a licence to buy and consume alcohol from registered providers. In recent amendments to the Federal Criminal Code (Federal Decree By-Law No. 15 of 2020), 29 the Union Supreme Court, the highest court in the UAE, issued a new judgement regarding the position on the use and possession of alcohol. As a result, the regulations on alcohol consumption were again amended to reflect the changing society.
The above-mentioned court also stipulates that if an Emirate’s local law prohibits the consumption of alcohol (and the Emirate has jurisdiction), this law should be applied instead of the Federal Criminal Code. As a result, residents in six Emirates no longer need a license to consume alcohol, whereas Sharjah strictly prohibits it. Nonetheless, the legal drinking age of 21 was maintained, as was a zero-tolerance policy for drinking and driving, being in public while intoxicated and selling or serving alcohol to Muslims.
The UAE has a zero-tolerance for the recreational use and possession of narcotic drugs such as cannabis, cocaine, heroin, methadone, opium and psychotropic drugs, for example, painkillers, unless part of a supervised and regulated medical and scientific activity. 26 Heavy penalties were given for violations, including prison sentences, fines and deportation for expats. 30 In 2021, the laws changed, providing a second chance for first-time offenders and averting prison sentences; dependent individuals who voluntarily present themselves and those reported by family members receive rehabilitation instead of prosecutions. 26 An Emirati arrested for drug offenses may be required to complete a two-year rehabilitation program. 31
The WHO Status Report on Alcohol and Health in 2018 32 reported an increase in per capita pure alcohol consumption, from 3.1 L in 2010 to 3.6 L in 2016 in the UAE, making it one of the highest in the Arab World. In a preliminary estimate, Doran 18 reported that out of a total population of 8.26 million in the UAE in 2012, 380 085 (>5%) used cannabis, 14 077 (0.2%) used alcohol in a harmful manner and 1408 (0.02%) used opiates. 18 In addition, the cost of addiction was estimated at US$5.47 billion in 2012. In a 6-year review of UAE drug trends, Alhassan et al 33 found that the number of patients admitted to the Government’s NRC for treatment increased significantly. In 2013, there were 545 admissions, 417 of which were first-time treatment admissions, compared with 1750 in 2018 and 502 first-time treatment seekers. 33 Recently, the Ministry of the Interior (Police) announced statistics on drug-related crime in the UAE. Alarmingly, 8428 people were arrested in the UAE for drug-related crimes in 2021, up 20.8% from 6973 in 2020, confirming a high demand and supply of narcotic drugs in the UAE, despite harsh penalties for those who manufacture, export, transport, and purchase, sell, and store them. 34
To summarise, in light of the increase of ASD in the UAE communities, the long-term adverse effect of ASD, the limitations of the systematic review mentioned earlier, 15 and the growing body of research on ASD in the UAE, a systematic search on the scientific literature on ASD in the UAE that includes all cultural and religious backgrounds over the last 50 years is needed. A scoping review is the most appropriate evidence synthesis to synthesise scientific literature in the UAE. 35 36 Such knowledge can be used to identify research gaps and guide future scientific inquiry, ensuring that resources are used effectively to combat ASD in the UAE. However, a preliminary search in MEDLINE, the Cochrane Database of Systematic Reviews, PROSPERO and the Joanna Briggs Institute (JBI) Evidence Synthesis on 15 November 2022 and 28 February 2023 revealed no active or ongoing systematic reviews or scoping reviews on ASD in the UAE.
The proposed scoping review will be conducted following the JBI’s methodology for scoping reviews, 36 and a team of social work faculty members at the Department of Social Wellbeing, UAE University will execute the review. Reporting of the findings will align with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. 37
The JBI’s, PCC framework 36 was used to develop the following review questions (see table 1 ): What can be learnt from a review of scientific literature on ASD in all ethnic and religious groups in the UAE?
The participant, concept and concept framework