Schema Modes and Addiction Relapse in Methadone-Treated Individuals: The Mediating Roles of Quality of Life and Rumination
Downloads
Objective: This study aimed to develop a structural model of addiction relapse based on schema modes, with quality of life and rumination as mediating variables among individuals receiving methadone treatment.
Methods and Materials: This descriptive-correlational study was conducted using structural equation modeling. The study population included clients undergoing methadone treatment in addiction treatment centers in Qazvin, Iran, in 2025. A total of 310 participants were selected through convenience sampling. Data were collected using the Addiction Relapse Questionnaire, Schema Mode Questionnaire, World Health Organization Quality of Life Questionnaire, and Rumination Questionnaire. Data were analyzed using SPSS version 26 and AMOS. The proposed model was evaluated using structural equation modeling and model fit indices.
Findings: The structural model showed acceptable fit indices, including χ²/df = 2.10, RMSEA = .05, CFI = .94, NFI = .91, GFI = .96, and AGFI = .94. Schema modes had a significant positive direct effect on addiction relapse (β = .40, p < .001) and rumination (β = .41, p < .001), while quality of life had a significant negative direct effect on relapse (β = −.34, p < .001). Schema modes also significantly predicted quality of life negatively (β = −.53, p < .001). Indirect effects of schema modes on relapse through rumination (β = .20, p < .001) and quality of life (β = .18, p < .001) were significant.
Conclusion: Schema modes, rumination, and quality of life are important psychological factors associated with addiction relapse among individuals receiving methadone treatment. Interventions targeting maladaptive schemas, rumination reduction, and quality-of-life improvement may support relapse prevention.
Downloads
Afkari, M. E., Ghasemi, A., Shojaeizadeh, D., Tol, A., Foroshani, A. R., & Taghdisi, M. H. (2013). Comparison between family function dimensions and quality of life among amphetamine addicts and non-addicts. Iranian Red Crescent Medical Journal, 15(4), 356. https://doi.org/10.5812/ircmj.9947
Armoon, B., Fleury, M.-J., Bayat, A.-H., Bayani, A., Mohammadi, R., & Griffiths, M. D. (2022). RETRACTED ARTICLE: Quality of life and its correlated factors among patients with substance use disorders: a systematic review and meta-analysis. Archives of Public Health, 80(1), 179. https://doi.org/10.1186/s13690-022-00940-0
Bachhuber, M. A., Cunningham, C. O., & Jordan, A. E. (2025). Potential improvement in spatial accessibility of methadone treatment with integration into other outpatient substance use disorder treatment programs, New York City, 2024. PLoS One, 20(2), e0317967. https://doi.org/10.1371/journal.pone.0317967
Ben-Shlomo, S., Angel, M., Werbeloff–Becker, N., & Roska, P. (2025). Enhancing life satisfaction among individuals receiving methadone treatment: The contribution of childhood experiences, personal variables, and therapeutic alliance with the social worker. The British Journal of Social Work, 55(4), 1716-1734. https://doi.org/10.1093/bjsw/bcaf016
Bentler, P. M. (2010). SEM with simplicity and accuracy. Journal of Consumer Psychology, 20(2), 215-220. https://doi.org/10.1016/j.jcps.2010.03.002
Bojed, F. B., & Nikmanesh, Z. (2013). Role of early maladaptive schemas on addiction potential in youth. International journal of high risk behaviors & addiction, 2(2), 72. https://doi.org/10.5812/ijhrba.10148
Cao, Q., Zhao, H., Yao, J., & Liang, Y. (2021). Anxiety and sleep quality in Chinese persons with a substance use disorder: A moderated mediation model of rumination and mindfulness. Current Psychology, 40(6), 2715-2724. https://doi.org/10.1007/s12144-019-00200-5
Esmaeeilzadeh, A., Toozandehjani, H., Zendehdel, A., & Bagherzadeh Golmakani, Z. (2025). Effectiveness of mindfulness-based cognitive therapy on rumination, distress tolerance, and negative hyperemotional dimensions among individuals with substance abuse. Journal of Fundamentals of Mental Health, 27(3), 181. 10.22038/JFMH.2025.81064.3143
Ferguson, E., Busch, A. M., Anderson, B., Abrantes, A. M., Pinkston, M. M., Baker, J. V., Stein, M. D., & Uebelacker, L. A. (2024). Avoidance and rumination as predictors of substance use, mental health, and pain outcomes among people living with HIV. Behavior therapy, 55(5), 1015-1025. https://doi.org/10.1016/j.beth.2024.02.008
Hand, L. J., Paterson, L. M., & Lingford-Hughes, A. R. (2024). Re-evaluating our focus in addiction: emotional dysregulation is a critical driver of relapse to drug use. Translational psychiatry, 14(1), 467. https://doi.org/10.1038/s41398-024-03159-5
Jamshidi, S., Asghari Ebrahimabad, M. J., & Rasoulzadeh Tabatabaee, K. (2020). The role of early maladaptive schemas in predicting the risk of substance abuse relapse. Middle Eastern Journal of Disability Studies, 10, 123-123. 20.1001.1.23222840.1399.10.0.131.0
Karimi, Z., Rezaee, N., Shakiba, M., & Navidian, A. (2019). The effect of group counseling based on quality of life therapy on stress and life satisfaction in family caregivers of individuals with substance use problem: a randomized controlled trial. Issues in mental health nursing, 40(12), 1012-1018. https://doi.org/10.1080/01612840.2019.1609635
Khosravani, V., Seidisarouei, M., & Alvani, A. (2016). Early maladaptive schemas, behavioral inhibition system, behavioral approach system, and defense styles in natural drug abusers. Polish Annals of Medicine, 23(1), 6-14. https://doi.org/10.1016/j.poamed.2015.12.003
Köhlerová, M. Z., Fišerová, Z., & Páv, M. (2024). Physical activity habits and their effects on quality of life in patients with addiction: data from the Czech Republic. Current Psychology, 43(4), 3150-3157. https://doi.org/10.1007/s12144-023-04402-w
Liao, X., & Zhang, Y. (2023). Stylistic and linguistic variations in compliments: an empirical analysis of children’s gender schema development with machine learning algorithms. Humanities and Social Sciences Communications, 10(1), 151. https://doi.org/10.1057/s41599-023-01648-4
Lin, K., Jia, J., Zhu, X., Zhang, B., Zhu, Z., Li, L., & Sun, J. (2025). Drug addiction and impact of urbanization: a systematic review. Current Opinion in Psychiatry, 38(3), 235-251. https://doi.org/10.1097/YCO.0000000000000997
Mao, S., Chou, T., & D’Orsogna, M. R. (2024). A probabilistic model of relapse in drug addiction. Mathematical biosciences, 372, 109184. https://doi.org/10.1016/j.mbs.2024.109184
Martinotti, G., Alessi, M. C., Di Natale, C., Sociali, A., Ceci, F., Lucidi, L., Picutti, E., Di Carlo, F., Corbo, M., & Vellante, F. (2020). Psychopathological burden and quality of life in substance users during the COVID-19 lockdown period in Italy. Frontiers in Psychiatry, 11, 572245. https://doi.org/10.3389/fpsyt.2020.572245
McNeil, N. M., & Alibali, M. W. (2019). A strong schema can interfere with learning: The case of children’s typical addition schema. Proceedings of the twenty-fourth annual conference of the Cognitive Science Society, https://doi.org/10.4324/9781315782379-149
Mehrabi, h., neshatdoust, h. T., & moulavi, h. (2004). Fa1yiily training as a supplementary introversion to relapse reduction of out-patient addicts in isfahan addicts rehabilitation center. https://sid.ir/paper/54400/en
Memedovic, S., Slade, T., Ross, J., Darke, S., Mills, K. L., Marel, C., Burns, L., Lynskey, M., & Teesson, M. (2019). Rumination and problematic substance use among individuals with a long-term history of illicit drug use. Drug and alcohol dependence, 203, 44-50. https://doi.org/10.1016/j.drugalcdep.2019.05.028
Mohammadi Benmar, A., Kakavand, A., Fahime, Z., & Ahmadi, M. (2023). The Association between Perceived Stress and Mobile Phone Addiction in COVID-19 Epidemic: The Role of Rumination and Self-Control. Journal of Psychological Studies, 19(1), 93-107. 10.22051/psy.2023.41381.2667
Nasiri, A., Sebzari, A. R., & Mehrpooya, N. (2020). The Effect of Dignity therapy on quality of life in patients with cancer: A Randomized Controlled Clinical Trial. Journal of Nursing Education, 9(2), 63-74. https://jne.ir/browse.php?a_code=A-10-1199-2&sid=1&slc_lang=en&ftxt=1&pure_pdf=1
Pasareanu, A. R., Opsal, A., Vederhus, J.-K., Kristensen, Ø., & Clausen, T. (2015). Quality of life improved following in-patient substance use disorder treatment. Health and quality of life outcomes, 13(1), 35. https://doi.org/10.1186/s12955-015-0231-7
Pourafshari, R., Rezapour, T., Rafei, P., & Hatami, J. (2022). The role of depression, anxiety, and stress in problematic smartphone use among a large sample of iranian population. Journal of Affective Disorders Reports, 10, 100436. https://doi.org/10.1016/j.jadr.2022.100436
Rahbarian, M., Mohammadi, A., Abasi, I., & Soleimani, M. (2017). Emotion regulation problems and addiction potential in Iranian students. Practice in Clinical Psychology, 5(4), 235-242. https://doi.org/10.29252/nirp.jpcp.5.4.235
Roediger, E., Stevens, B. A., & Brockman, R. (2018). Contextual schema therapy: An integrative approach to personality disorders, emotional dysregulation, and interpersonal functioning. New Harbinger Publications. https://psycnet.apa.org/record/2018-30793-000
Sinha, R. (2024). Stress and substance use disorders: risk, relapse, and treatment outcomes. The Journal of clinical investigation, 134(16). https://doi.org/10.1172/JCI172883
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological methodology, 13, 290-312. https://doi.org/10.2307/270723
Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection. Journal of personality and social psychology, 76(2), 284. https://doi.org/10.1037/0022-3514.76.2.284
Van Vreeswijk, M., Broersen, J., & Nadort, M. (2012). The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice. John Wiley & Sons. https://doi.org/10.1002/9781119962830
Wright, F. D., Beck, A. T., & Newman, C. F. (1993). Cognitive Therapy of Substance. Behavioral treatments for drug abuse and dependence, 137, 123. https://doi.org/10.1037/e495912006-008
Yeh, Y.-H., Zheng, M. H., Tegge, A. N., Athamneh, L. N., Freitas-Lemos, R., Dwyer, C. L., & Bickel, W. K. (2024). The phenotype of recovery XI: associations of sleep quality and perceived stress with discounting and quality of life in substance use recovery. Quality of Life Research, 33(6), 1621-1632. https://doi.org/10.1007/s11136-024-03625-z
Zibaei, M., Shakerinasab, M., & Mirzaei, S. H. (2020). Relationship between early maladaptive schemas and irrational beliefs with drug addiction tendency in young men admitted to Bojnourd addiction treatment camps. AppliedResearchBureau of the police force of northern khorasan, 7(27), 83-111. https://www.magiran.com/paper/2643560/relationship-between-early-maladaptive-schemas-and-irrational-beliefs-with-drug-addiction-tendency-in-young-men-admitted-to-bojnourd-addiction-treatment-camps?lang=en
Copyright (c) 2025 International Journal of Body, Mind and Culture
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
