Abstract Objectives This study was designed to assess the patterns and severity of drug and alcohol problems of a group of patients presenting for treatment at a substance abuse treatment program in Egypt. Methods A total of 268 patients with drug/alcohol problems were interviewed at the Ain Shams Institute of Psychiatry in Cairo over a period of 1 year (2005 to 2006) using the Arabic version of the Addiction Severity Index, 5th edition. One hundred sixty patients were interviewed during the intake session and the other 108 were interviewed within the first week of their admission to the treatment program. Results In the past 30 days before admission to the treatment program, 30% of the patients reported medical problems, 38% reported employment problems, 9% reported illegal activities, 62% reported serious conflicts with their families, 37% reported serious conflicts with other people, and 64% reported one or more psychiatric symptoms. The major drug problem was heroin for 52% of the patients, other opiates for 23%, and other drugs, including alcohol, for the remaining 25% of the patients. Conclusions Opiates were the major drug problem for most of our patients, representing 75% of cases, whereas barbiturates, stimulants, hallucinogens, and inhalants were rarely found to be the major drug problem for patients. Injection was a significant problem for heroin users that needs to be addressed in treatment programs.