Comparing the Effects of Enriching Couples' Relationships and Training Skills Based on Improving Quality of Life on Tolerance of Distress in Women Rehabilitated From Drug Use

 According to the Diagnostic and Statistical Manuals of Mental Disorders–Fifth Edition (DSM–5), individuals with Substance Use Disorders (SUDs) continue to use drugs despite the emerging cognitive and bio–behavioral symptoms. Most individuals consider SUDs to be a male phenomenon. However, there is an increase in the frequency of women with SUDs. Low tolerance of distress can be a contributing factor to various SUDs. Individuals with low distress tolerance engage in destructive behaviors, such as substance abuse to cope with their negative emotions and alleviate their emotional pain. Studies indicated that high levels of distress tolerance are associated with an increased risk of developing SUDs and an elevated risk of relapse. The present study aimed to compare the effects of the training of enriching couples' relationships per choice theory and teaching skills based on improving quality of life on the tolerance of distress in women who were rehabilitated from SUDs.

 This was a quasi–experimental study with pretest–posttest, a 3–month follow–up, and a control group design. The statistical population of the study was women who were rehabilitated from SUDs and participated in the groups of Narcotics Anonymous (NA) in Neishabour City, Iran, from October 2019 to November 2019. Sixty individuals were selected by the convenience sampling method. Then, 40 subjects were randomly assigned to the experimental groups of training enriching couples' relations and teaching skills based on improving the quality of life, and 20 subjects were placed in the control group. The inclusion criteria of the study were married women, participating in training sessions with husbands, not having a mental disorder (this criterion was assessed by a mental health interview), and no SUDs in spouses. The exclusion criteria of the study were absence from >3 sessions, relapse during the program implementation, the recurrence of SUDs in spouses in the past. Data collection tools were performed in 3 stages, including the Distress Tolerance Scale (Simons & Gaher, 2005). For the first experimental group, the training sessions of enriching the relationship of couples based on choice theory, per the model of Duba et al. (2009) were presented in 3 stages of 6 ninety–minute sessions. For the second experimental group, quality–of–life skills training sessions were presented in 8 ninety–minute sessions based on Frisch’s (2006) intervention program. The first experimental group participated in the training sessions based on Duba, Graham, Britzman, and Minatra’s models. Moreover, the control group remained on the waiting list. After three months, the follow–up test was performed. In this study, descriptive statistics, including mean and standard deviation were used to analyze the obtained data; at the level of inferential statistics, repeated–measures Analysis of Variance (ANOVA) and Tukey’s post hoc test was used in SPSS. The significance level of the tests was considered 0.05.

 The present study results suggested that the mean changes of the distress tolerance variable were significant over time (p=0.006). The effect of the group was also significant (p=0.009); respecting distress tolerance, in the posttest and follow–up stages, a significant difference was observed between the mean scores of the experimental group of enriching couples' relationships and the control group (p=0.015, p=0.021, respectively). In the posttest phase, there was a significant difference between the mean score of the experimental group of quality of life–based skills and the control group in distress tolerance (p=0.003). However, in the follow–up stage, there was no significant difference between the scores of these two groups in distress tolerance (p=0.102). Furthermore, in the posttest and follow–up stages, there was no significant difference between the group of couples' relationship enrichment and the group of quality of life–based skills in the mean score of stress tolerance (p=0.619, p=0.381, respectively).

 According to the obtained findings, enriching couples' relationships and improving the quality of life training increased distress tolerance in women rehabilitating from SUDs.