The Role of Early Maladaptive Schemas in Predicting the Risk of Substance Abuse Relapse

Substance dependence is a reversible brain disorder. Research studies indicated that >75% of individuals with drug use disorders experienced a relapse within one year after treatment. Relapse prevention is a strategy to reduce the odds and severity of relapse after stopping or reducing harmful behaviors. Concerning the etiology of substance abuse relapse, special attention has recently been paid to cognitive causes. Considering the essential role of cognition in substance abuse relapse, the present study aimed to determine the relationship between early maladaptive schemas and the risk of substance abuse relapse.

The present descriptive–correlational study used multiple regression analysis methods. The statistical population of the present study included all patients with substance dependence aged 20 to 45 years in Mashhad City, Iran, in 2018–2019. To select the study sample, of the total 3555 clients of substance dependence treatment camps and clinics, 689 individuals who were diagnosed with a drug use disorder and had an experience of >6 months past relapse since their abstinence were selected using the convenience sampling method. The Young Schema Questionnaire (1998) and Identifying People in Risk of Addiction (I.P.R.A) Questionnaire (Anisi, 2012) were employed for data collection. The correlation coefficients for the subscales of early maladaptive schemas were obtained to fall in the range of 60% to 85% for test reliability. Furthermore, its content validity was reported to be 0.42 using the test–retest method. Cronbachchr('39')s alpha coefficient of 0.97 was reported for the I.P.R.A questionnaire. This instrument also presented desirable validity and reliability. A written informed consent form was received from all study participants. Besides, they were informed that participation in the present research project is voluntary. Their identity and all the information obtained from them remained confidential by the researcher. The ethical principles of the American Psychiatric Association were also observed at all study stages. The collected data were analyzed by descriptive statistics, as well as multiple correlations and regression tests in SPSS. In addition, p<0.05 was considered as statistically significant.

The Pearson’s correlation coefficient data suggested a significant correlation between the risk of substance abuse relapse (p<0.001) and all of the early maladaptive schemas, including failure (0.685), defectiveness/shame (0.627), emotional deprivation (0.569), insufficient self–control/self–discipline (0.771), vulnerability to harm or illness (0.548), entitlement/grandiosity (0.470), enmeshment/undeveloped self (0.522), mistrust (0.579), emotional deprivation (0.491), social isolation/alienation (0.679), self–sacrifice (0.330), abandonment/instability (0.487), subjugation (0.649), unrelenting standards/hyper criticalness (0.662), and dependency/incompetence (0.474). Accordingly, the variables of the early maladaptive schemas could all together predict 72% of the variance in the risk of substance abuse relapse. The concurrent regression analysis results indicated that the subscales of failure, insufficient self–control/self–discipline, emotional deprivation, subjugation, dependency/incompetence, and dependence/incompetence could predict the risk of substance abuse relapse (p<0.001).

Considering the association between early maladaptive schemas and the risk of substance abuse relapse, addiction experts could use these findings in preventing relapse and substance dependence treatment. Coping with early maladaptive schemas in childhood and adolescence before leading to substance abuse and other problems may reduce the subsequent need for the treatment of drug and alcohol use.