Authors: Mohammed Abdullah AlHejji , Abubakr Elmotesim Abdulla Elamin , Hassan Ahmad Khubrani , Sameera Gamal Moubark Mohamed , Adam Mohamed Saber Mohamed , Amira Gaber Ibrahim Mostafa

Abstract

Background: Substance use disorders (SUDs) require structured detoxification and rehabilitation. Patients often adapt to treatment environments by observing and responding to staff behaviors and institutional routines, described as Behavioral Manipulation Patterns (BMPs). Understanding these patterns is important for optimizing patient–provider interactions.

Methods: A qualitative observational study was conducted at the ReLib Center, including 78 patients admitted between January and March 2025. Data from clinical notes, incident reports, multidisciplinary meetings, and staff feedback were analyzed using thematic analysis to identify recurrent behavioral patterns.

Results: Patients rapidly developed awareness of institutional routines, often within the first 72 hours, enabling anticipatory and adaptive behaviors. Common patterns included adjustment of communication styles based on staff dynamics, use of emotionally expressive strategies, and repeated boundary testing. Behavioral complexity varied according to cognitive functioning.

Conclusions: Patients actively adapt to structured treatment environments through observable behavioral strategies. Recognizing these patterns can improve staff preparedness, promote consistent clinical responses, and strengthen therapeutic engagement. Structured training, standardized communication, and clear institutional boundaries are recommended to support effective and patient-centered care.

Keywords: Substance use disorders (SUDs), detoxification, rehabilitation, adaptive behavioral responses, institutional adaptation, patient–provider interaction, addiction treatment.