Structural Equation Modeling of Drug Craving in Addicted People Under Methadone Maintenance Treatment Based on Irrational Beliefs, Emotion Regulation Skills, and Cognitive Fusion

Substance use disorders are defined by repeated and uncontrollable use of psychotropic substances and lead to disability and psychological disturbance of users. There are several treatments for this disorder, including methadone maintenance therapy. The literature reveals that irrational beliefs are one of the effective variables in studies related to rehabilitation and treatment of addiction. Another effective variable in this regard is emotion regulation skills. One of the main correlates of the ability to regulate emotions and manage irrational beliefs is the concept of cognitive fusion. The extent to which emotion regulation skills and irrational beliefs predict craving problems and the mediating role of cognitive fusion is unclear. The current study aimed to introduce a structural equation model of drug craving in addicted people under methadone maintenance treatment based on irrational beliefs and emotion regulation skills through the mediating role of cognitive fusion.

The current research was a correlation study based on structural equation modeling that analyzed the relationship between research variables in path analysis. The statistical population of this study comprised addicts under maintenance treatment with methadone who were referred to outpatient treatment centers under the supervision of the State Welfare Organization in district 14 of Tehran City, Iran, during the time interval of research. For sampling, seven centers were initially randomized. Then, from each center, 25 people with research criteria were selected purposefully. Depending on the number of parameters, the sample size was 9 times the number of parameters (31 parameters), equivalent to 279 persons. But 21 questionnaires were excluded because they were incomplete, so 258 were studied. The research instruments included Drug Temptation Questionnaire (Salehi Fadardi & Barerfan, 2009), the Cognitive Emotion Regulation Questionnaire (Garnefski et al., 2001), Irrational Beliefs Questionnaire (Jones, 1968), and Cognitive Fusion Questionnaire (Gillanders et al., 2014). Data were analyzed by SPSS software version 24 and AMOS 24 at a significant level of 0.05 by structural equation modeling.

Results:

The results showed that the conceptual model fits the collected data (χ2/df=1.39, CFI=0.932, GFI=0.902, AGFI=0.869, and RMSEA=0.060). The total effect (sum of direct and indirect effect coefficients) of irrational beliefs on cognitive fusion (p=0.001, β=0.290), non–adaptive strategies on cognitive fusion (p=0.001, β=0.330), and adaptive strategies on cognitive fusion (p=0.016, β=–0.171) were significant. Also, the total effect of non–adaptive strategies on drug craving (p=0.001, β=0.354), irrational beliefs on drug craving (p=0.001, β=0.461), and cognitive fusion on drug craving (p=0.001, β=0.413) was significant. The indirect effect of non–adaptive strategies on drug craving (p=0.001, β=0.136) and the indirect effect of adaptive strategies on drug craving (p=0.014, β=–0.070) were significant. Also, the indirect effect of irrational beliefs on drug craving was significant (p=0.001, β=0.120).

Based on the current research findings, irrational beliefs and emotion regulation strategies through cognitive fusion affect the drug craving of people undergoing maintenance treatment with methadone.