The Relationship between Self-Compassion and Self-Efficacy in Predicting Relapse Risk among Methamphetamine Users

The Relationship between Self-Compassion and Self-Efficacy in Predicting Relapse Risk among Methamphetamine Users | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship between Self-Compassion and Self-Efficacy in Predicting Relapse Risk among Methamphetamine Users Sahel Kanjouri, Mehdi Merati, Maryam Khanegi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6846491/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Substance Use Disorder (SUD) is a complex social phenomenon that continues to rise across diverse human societies, despite growing knowledge and awareness of its consequences. Psychological factors can diminish the effectiveness of opioid withdrawal interventions. Therefore, this study was conducted to assess the effects of self-compassion and self-efficacy on relapse rates among methamphetamine users over a one-year follow-up period in Kermanshah, Iran. Methods : This cross-sectional study involved 105 patients (mean age = 36.00, SD = 10.72) diagnosed with SUD, randomly selected from those admitted to the Farabi Psychological Center in Kermanshah in 2023. Data were collected using the Self-Compassion Scale, General Self-Efficacy Scale, Substance Abuse Risk Questionnaire, and a demographic questionnaire. Collected data were analyzed using Pearson correlation and multivariate regression with SPSS 18.0 software. RESULTS: The average age of the patients was 36.00 ± 10.72 and 95 (91.3%) patients were male. The findings of the research showed that the total self-compassion score of the participants was 2.90± 0.31.The self-efficacy score of the subjects was 47.52 ±11.11 on average, and the levels of both variables were low in most patients. The scores obtained from responding to the risk of substance abuse relapse questionnaire were on average 105.43 ±16.92 and most people had an average level of relapse risk. Among the studied variables, the relationship of self-compassion and self-efficacy with drug relapse was highly significant and inverse (p<0.001). The self-efficacy variable with a standard regression coefficient of -0.441 has been the most important in explaining the variance of the risk of drug relapse. Conclusions: Based on the findings regarding the impact of self-compassion training on reducing craving and enhancing self-efficacy in patients with methamphetamine dependence, we recommend integrating self-compassion skills training into drug rehabilitation centers and hospital wards to complement conventional therapies. Self-compassion substance use disorders self-efficacy relapse risk Introduction Substance Use Disorder (SUD), as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), is a maladaptive pattern of substance use leading to significant psychological distress or functional impairment( 1 ). In 2022, an estimated 292 million people—5.6% of the global population aged 15–64 engaged in illicit drug use, marking a 20% increase from a decade ago( 2 ). In Iran, SUD affects approximately 2.8 million individuals, with regions like Kermanshah facing particularly high rates of substance use and addiction-related mortality, posing substantial public health challenges ( 3 , 4 ). The repercussions of SUD extend beyond individuals, disrupting family dynamics, straining social systems, and burdening healthcare infrastructures( 5 , 6 ). Despite its increasing prevalence and complexity, current interventions often fall short, particularly in identifying psychosocial risk factors and enhancing long-term treatment adherence( 7 ). As the global burden of SUD is projected to rise, there is a growing consensus on the necessity of patient-centered and individualized therapeutic models. Relapse and psychological vulnerabilities relapse, defined as the return to substance use following a period of abstinence, occurs in approximately 40–60% of patients within the first year post-treatment( 8 ). This process typically unfolds across emotional, mental, and behavioral dimensions and is frequently precipitated by psychological vulnerabilities such as impaired emotion regulation and diminished self-efficacy( 9 ). While considerable research has focused on pharmacological and behavioral treatments, less attention has been paid to the interplay of psychological strengths that may buffer against relapse( 10 ). Role of self-Compassion and self-Efficacy among these strengths, self-compassion—characterized by self-kindness, mindfulness, and a sense of shared humanity—has shown promise as an adaptive emotion regulation strategy associated with greater psychological resilience and reduced engagement in high-risk behaviors( 11 ). Similarly, self-efficacy, or an individual’s belief in their capacity to manage challenges, has consistently emerged as a robust predictor of sustained abstinence( 12 ). However, limited empirical work has examined their combined predictive value, particularly in high-risk populations. The present study seeks to address this gap by investigating whether higher levels of self-compassion and self-efficacy are associated with reduced risk of relapse in individuals with SUD residing in Kermanshah, a region with elevated rates of substance use and addiction-related mortality( 4 ). Using a longitudinal design with a six-month follow-up, this research aims to inform targeted psychosocial interventions and support the development of more effective relapse prevention strategies. Materials and methods Design and setting This cross-sectional study was conducted at the Farabi Center, a psychiatric health hospital affiliated with Kermanshah University of Medical Sciences (KUMS). As the primary psychological institution in western Iran, Farabi Hospital provides advanced psychological services. The study employed a convenience sampling method, involving 105 individuals diagnosed with SUD. The Ethics Committee of KUMS approved the study, ensuring adherence to human rights, ethical standards, and safety throughout all procedures. All participants provided written informed consent prior to assessment. (Ethics code: IR.KUMS.MED.REC.1401.2). Clinical trial number: not applicable. To ensure confidentiality, participants completed questionnaires in a private conference room, with each session lasting approximately 30 minutes. Sample Size The sample size was determined based on a pilot study, using a 95% confidence level and a 5% margin of error. According to the Cochrane table for sample size determination, a minimum of 84 participants was required. Accounting for a potential 25% dropout rate, a sample size of 105 were deemed appropriate. Inclusion and exclusion criteria Inclusion criteria included a diagnosis of opioid use disorder, willingness to participate and complete questionnaires, ability to understand the study procedures, and provision of informed consent. Exclusion criteria included non-cooperation in completing questionnaires, severe mental health conditions impairing accurate responses, chronic psychiatric disorders, and significant medical conditions affecting cognitive function, history of brain injuries, intellectual disability, pregnancy, or unwillingness to participate. Assessment tools : Self-Compassion Scale The Self-Compassion Scale, a 26-item self-report questionnaire, assessed self-compassion at three time points( 13 ). Participants rated items (e.g., “I try to be understanding and patient toward aspects of my personality I don’t like”) on a 5-point Likert scale from “Almost Never” to “Almost Always,” with higher scores indicating greater self-compassion. The SCS includes six subscales assessing three bipolar facets: self-kindness versus self-judgment, mindfulness versus over-identification, and common humanity versus isolation. The SCS demonstrated good reliability and validity in this study, with internal consistency ranging from α = 0.87 to 0.90( 14 – 17 ). The General Self-Efficacy Scale The General Self-Efficacy Scale, developed by Schwarzer and Jerusalem, has been translated into 28 languages( 18 ). This questionnaire uses a 5-point Likert scale, with items 1, 2, 3, 6, 13, and 15 scored from “completely disagree” (0) to “completely agree” ( 5 ), and other items reverse-scored. Total scores range from 17 to 85, categorized as low ( 17 – 34 ), moderate (35–51), or high (above 51) self-efficacy. Relapse risk Questionnaire The Substance Abuse Relapse Risk Questionnaire, developed by Ogai et al. (2007) and subsequently validated by Wright (2018), comprises 35 closed-ended items rated on a 5-point Likert scale from “completely disagree” ( 1 ) to “completely agree” ( 5 ). The questionnaire includes five subscales evaluating different aspects of substance use: anxiety and intention to consume (eight items), emotional problems (eight items), compulsion to consume (four items), positive expectations and lack of control over consumption (six items), and lack of negative expectations from the substance (four items). Additionally, it features a lie detection scale with five items to assess individuals’ insight into their substance abuse issues. Total scores range from 35 to 175, with scores between 35 and 70 indicating a low relapse risk, 70 to 140 indicating a moderate risk, and above 140 indicating a high risk ( 19 ) ( 20 ). Socio-demographic information Socio-demographic information including age, gender, and marital status, history of smoking and alcohol use, and economic characteristics (including family income, house ownership, and living status). Data analysis The Statistical Package for the Social Sciences (SPSS) (ver. 23.0) was used for the purpose of data entry, manipulation, and analysis. Quantitative variables were expressed as mean ± standard deviation (µ ± SD), and qualitative/categorical ones as frequencies and percentages. Bivariate Pearson correlation coefficient was utilized to ascertain the magnitude, and direction of the associations between the relapse with the Self-Compassion and Self-Efficacy. Linear regression analysis (stepwise method) was performed to explain the variation of the relapse, based on the Self-Compassion, Self-Efficacy, and demographic variable. Results Their mean age was 36.00 ± 10.72 (µ ± SD) years. A of 95 participants (91.3%) were male and 26.9% had primary education. Most participants (56.6%) were married .In addition, 61.5% had a history of drug abuse Table 1 . Table 1 ; Sociodemographic, economical, and clinical information of participants (n = 105). Characteristics N (%) Relapse Mean (SD) p Age 20–30 40(38.5%) 106.37(16.60) 0.554 31–40 30(28.8%) 102.60(17.63) 40< 34(32.7%) 106.85(16.85) Gender Female 9(8.7%) 27 (19.3) 0.347 Male 95(91.3%) 113 (80.7) Marital status Single 39(39.4%) 97 (69.3) 0.778 Married 55(56.6%) 43 (30.7) Divorced-widow 4(4.0%) 99.50(13.08) House ownership Tenant 66(64.1%) 104.58 (16.50) 0.327 Landlords 37(35.9%) 107.97 (16.86) Smoking Yes 64(61.5%) 105.46 (16.96) 0.980 No 40(38.5%) 105.37 (17.06) Education Elementary 28(26.9%) 104.21 (20.07) 0.545 High school and diploma 44(42.3%) 107.54 (14.94) College and above 31(30.8%) 103.51 (16.70) The mean of risk of relapse, self-compassion and general self-efficacy is 105.43 ± 16.92, 2.90 ± 0.31 and 47.52 ± 11.11 respectively Table 2 . Table 2 ; Frequency distribution of drug relapse risk levels, self-compassion and self-efficacy among patients mean level N (%) Risk of relapse 105.43(16.92) Low 4 (3.9%) intermediate 99(95.2%) high 1(1.0%) Self-compassion 2.90(0.31) Low 2(1.9%) intermediate 102(98.1%) high - General self-efficacy 47.52(11.11) Low 21(21.2%) intermediate 71(68.3%) high 11(10.6%) According to Table 3 which shows the bivariate Pearson correlation between predictor variables (the distress tolerance and resilience) and criterion variable (relapse) which were most of them, statistically significant at either 0.01 level. For example, the distress tolerance was associated with the resilience (r = 0.975). Additionally, the distress tolerance (r = -0.693) and resilience (r = -0.725) were significantly related to the relapse. Table 3 ; Correlation between different components. Variable Factor X1 X2 X3 Risk of relapse r 1 -0.382** -0.520** P --- 0.0001> 0.0001> Self-compassion r --- 1 0.514** P --- --- 0.0001> General self-efficacy r --- --- 1 P --- --- --- *Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed). Table 4 indicates that the self-efficacy was able to explain 27.3% of the variation of the relapse. Likewise, there was a negative and significant relationship between the resilience and relapse (Beta=-0.441 and P = 4.442** (< 0.0001)). Table 4 Predictors of the relapse Variables Standardized Coefficients Beta t P-value Self-compassion -0.153 -1.540 0.127 General self-efficacy -0.441 -4.442** < 0.0001 R square = 0.536, Adjusted R square = 0.273, F = 19.97, P-value = < 0.0001 Discussion This study examined the psychological factors influencing relapse risk among methamphetamine users treated at Farabi Hospital in Kermanshah, Iran. Our findings reveal significant inverse relationships between self-compassion, self-efficacy, and the likelihood of relapse. These results align with prior research highlighting the role of emotional and cognitive factors in addiction recovery Over recent decades, addiction has been increasingly recognized as a manifestation of psychological distress. Research has focused on variables such as emotional regulation, attachment styles, and self-soothing capacities. While individual vulnerabilities are critical, external factors like family dynamics and cultural norms also significantly influence addiction and recovery processes( 21 ). For instance, Giannouli and Ivanova (2019) found that demographic characteristics, such as age, gender, and education, were not strong predictors of coping strategies among cannabis users, suggesting that addiction mechanisms extend beyond superficial traits ( 22 – 24 ). Instead, interpersonal relationships, environmental stressors, and societal expectations interact with internal processes to shape substance use behaviors. Thus, SUDs are deeply influenced by external factors, including familial relationships, societal norms, and environmental stressors. Among internal protective factors, self-compassion has emerged as pivotal in fostering emotional resilience. Unlike traditional coping mechanisms that primarily suppress symptoms, self-compassion addresses emotional underpinnings of substance use, such as shame, guilt, and self-criticism( 11 , 25 ). Relational experiences, particularly within families and romantic partnerships, may influence self-compassion development, indirectly affecting relapse risk. Our findings show that individuals with higher self-compassion exhibit healthier emotional responses and reduced vulnerability to relapse. However, research specifically examining self-compassion and SUDs remains limited ( 26 – 28 ). Recent studies have begun to address this gap. For instance, Shreffler et al. (2022) found that self-compassion is associated with personal growth and well-being in individuals with SUD, including those with methamphetamine use disorder.( 29 ). Similarly, Carlyle et al. (2019) demonstrated that brief compassion-focused therapy reduces SUD risk by fostering self-compassion, emphasizing interventions targeting self-criticism and promoting non-judgmental acceptance ( 30 ). In parallel, our research also identified self-efficacy as a significant protective factor. Individuals with higher self-efficacy beliefs were less prone to relapse, aligning with findings from Nikmanesh et al. (2017) and Hendianti (2018) ( 31 , 32 ). Zhang et al. (2016) reported that low self-efficacy is associated with more frequent relapses and a tendency to view relapse as personal failure( 33 ). Recent research has further explored self-efficacy in methamphetamine users. Ahmadi Jouybari et al. (2024) clustered methamphetamine users based on personality traits and self-efficacy, finding that different clusters had varying levels of mental health, sleep quality, and relapse risk, highlighting the importance of self-efficacy in recovery( 34 ) . Additionally, Schuck et al. (2014) illustrated the efficacy of enhancing self-efficacy in preventing smoking relapse during high-risk situations, reinforcing that high self-efficacy equips individuals to resist temptations, reducing relapse likelihood ( 35 ). These findings reinforce the idea that self-efficacy, as a personality trait, plays a crucial role in influencing substance use relapse. Individuals with high self-efficacy are better equipped to resist temptations, thereby reducing their likelihood of relapse( 36 ). This study provides compelling evidence for the protective roles of self-compassion and self-efficacy in reducing relapse risk among methamphetamine users. These findings contribute to the existing literature and suggest avenues for developing targeted psychosocial interventions that enhance these psychological strengths to support sustained recovery. Limitations While this study provides valuable insights into the role of self-compassion and self-efficacy in relapse prevention among methamphetamine users, it is essential to acknowledge several limitations that may influence the interpretation of the findings. First, the cross-sectional design of the study precludes establishing causal relationships between these psychological factors and relapse risk. Although associations were observed, it remains unclear whether self-compassion and self-efficacy directly influence relapse or if other variables mediate these relationships. Longitudinal studies are necessary to clarify the temporal and causal dynamics of these associations. Second, the sample was limited to individuals receiving treatment at Farabi Hospital in Kermanshah, which may restrict the generalizability of the results. The unique cultural, socioeconomic, and treatment contexts of this region might not be representative of other populations with substance use disorders. Therefore, replicating this research in diverse settings and with varied demographics would enhance the external validity of the findings. Third, the study relied on self-reported measures to assess self-compassion, self-efficacy, and relapse risk. Self-report data are susceptible to biases, such as social desirability and recall inaccuracies, which could affect the accuracy of the results. Incorporating objective measures, such as behavioral observations or physiological indicators, would provide a more robust evaluation of these constructs. Lastly, while self-compassion and self-efficacy were identified as protective factors, the underlying mechanisms through which they exert their effects remain underexplored. Future research integrating neurobiological assessments, such as neuroimaging, could elucidate the neural correlates of these psychological processes in the context of addiction recovery. To address these limitations, future studies should aim to: Replicate the findings in larger, more diverse samples to enhance generalizability. Employ longitudinal and experimental designs to establish causal relationships between self-compassion, self-efficacy, and relapse risk. Utilize multi-method approaches, including objective measures, to validate self-reported data. Conclusions This study underscores the transformative potential of self-compassion and self-efficacy as protective factors in mitigating relapse risk among individuals with methamphetamine use disorder. By fostering acceptance and resilience in the face of challenging emotions, self-compassion interventions offer a promising pathway to sustained recovery, addressing the emotional underpinnings of addiction, such as shame and self-criticism. Similarly, strengthening self-efficacy equips individuals to resist the temptations of substance use, enhancing their capacity to navigate high-risk situations with confidence. Declarations Ethics approval and consent to participate The ethical committee of the KUMS (Kermanshah University of medical sciences) approved the study protocol (ethics code IR.KUMS.MED.REC.1401.2). All participating provided written informed consent for participating in this study. The text of written informed consent was explained to illiterate individuals, if they were satisfied, the consent form was received. This study was performed in accordance with relevant guidelines and regulations in the Declaration of Helsinki. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding to declare. Author’s contributions MKh, MM, SK: Conception or design of the work; MM: Data collection; MKh: Data analysis and interpretation; MKh, MM, SK: Drafting the article, Critical revision of the article, and Final approval of the version to be submitted. Acknowledgements In this way, the authors would like to express their deepest gratitude and appreciation to Kermanshah University of medical sciences (KUMS), and all participants in this study. References Crone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, et al. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders. American Journal of Psychiatry. 2023;180(2):167-71. Heikkilä H, Maalouf W, Campello G. The United Nations Office on Drugs and Crime’s efforts to strengthen a culture of prevention in low-and middle-income countries. Prevention Science. 2021;22(1):18-28. Knox C, Wilson M, Klinger CM, Franklin M, Oler E, Wilson A, et al. DrugBank 6.0: the DrugBank knowledgebase for 2024. Nucleic acids research. 2024;52(D1):D1265-D75. Shahbazi F, Mirtorabi D, Ghadirzadeh MR, Hashemi-Nazari SS. Analysis of mortality rate of illicit substance abuse and its trend in five years in Iran, 2014-2018. Addiction & health. 2018;10(4):260. Diagnostic A. statistical manual of mental disorders. Washington, DC: American 7 Psychiatric Association. Text revision. 2000;8. First MB, Yousif LH, Clarke DE, Wang PS, Gogtay N, Appelbaum PS. DSM‐5‐TR: Overview of what’s new and what’s changed. World Psychiatry. 2022;21(2):218. Costello MJ, Li Y, Remers S, MacKillop J, Sousa S, Ropp C, et al. Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment. Addictive Behaviors. 2019;98:106055. Melemis SM. Relapse and relapse prevention. Alcohol use: assessment, withdrawal management, treatment and therapy: ethical practice: Springer; 2023. p. 349-61. Schulenberg J, Johnston L, O'Malley P, Bachman J, Miech R, Patrick M. Monitoring the Future national survey results on drug use, 1975-2019: Volume II, college students and adults ages 19-60. 2020. Mehmandoost S, Mirzazadeh A, Karamouzian M, Khezri M, Sharafi H, Shahesmaeili A, et al. Injection cessation and relapse to injection and the associated factors among people who inject drugs in Iran: The Rostam study. Substance Abuse Treatment, Prevention, and Policy. 2023;18(1):72. Neff KD. Self-compassion: Theory, method, research, and intervention. Annual review of psychology. 2023;74(1):193-218. Litt MD, Kadden RM, Tennen H, Dunn HK. Momentary coping and marijuana use in treated adults: Exploring mechanisms of treatment. Journal of consulting and clinical psychology. 2021;89(4):264. Karakasidou E, Pezirkianidis C, Galanakis M, Stalikas A. Validity, reliability and factorial structure of the Self Compassion Scale in the Greek population. Journal of Psychology and Psychotherapy. 2017;7(313):2161-0487. Neff KD. The development and validation of a scale to measure self-compassion. Self and identity. 2003;2(3):223-50. Basharpoor S. Psychometric properties of the persian version of the self compassion scale in university students. 2014. Neff KD, Tóth-Király I, Yarnell LM, Arimitsu K, Castilho P, Ghorbani N, et al. Examining the factor structure of the Self-Compassion Scale in 20 diverse samples: Support for use of a total score and six subscale scores. Psychological assessment. 2019;31(1):27. Williams MJ, Dalgleish T, Karl A, Kuyken W. Examining the factor structures of the five facet mindfulness questionnaire and the self-compassion scale. Psychological assessment. 2014;26(2):407. Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The self-efficacy scale: Construction and validation. Psychological reports. 1982;51(2):663-71. Wright AJ. Comprehensive assessment of substance abuse and addiction risk in adolescence. New Directions in Treatment, Education, and Outreach for Mental Health and Addiction. 2018:25-55. Ogai Y, Haraguchi A, Kondo A, Ishibashi Y, Umeno M, Kikumoto H, et al. Development and validation of the Stimulant Relapse Risk Scale for drug abusers in Japan. Drug and alcohol dependence. 2007;88(2-3):174-81. Harris MT, Laks J, Stahl N, Bagley SM, Saia K, Wechsberg WM. Gender dynamics in substance use and treatment: A women’s focused approach. The Medical Clinics of North America. 2022;106(1):219. Fairbairn CE, Briley DA, Kang D, Fraley RC, Hankin BL, Ariss T. A meta-analysis of longitudinal associations between substance use and interpersonal attachment security. Psychological bulletin. 2018;144(5):532. Rodriguez LM, Derrick J. Breakthroughs in understanding addiction and close relationships. Current opinion in psychology. 2017;13:115-9. Giannouli V, Ivanova D, editors. Perceived parents' and partners' attitudes towards female women with alcohol dependence: do they really matter? EUROPEAN PSYCHIATRY; 2019: ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER 65 RUE CAMILLE …. Germer C, Neff K. Teaching the mindful self-compassion program: A guide for professionals: Guilford Publications; 2019. Leary MR, Tate EB, Adams CE, Batts Allen A, Hancock J. Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Journal of personality and social psychology. 2007;92(5):887. Neff K. Self-compassion and psychological well-being. Constructivism in the human sciences. 2004;9(2):27. Graham C. Examining the role of self-compassion in acceptance and commitment therapy with a substance abusing population: Spalding University; 2016. Shreffler J, Thomas JJ, McGee S, Ferguson B, Kelley J, Cales R, et al. Self-compassion in individuals with substance use disorder: the association with personal growth and well-being. Journal of addictive diseases. 2022;40(3):366-72. Carlyle M, Rockliff H, Edwards R, Ene C, Karl A, Marsh B, et al. Investigating the feasibility of brief compassion focused therapy in individuals in treatment for opioid use disorder. Substance Abuse: Research and Treatment. 2019;13:1178221819836726. Hendianti GN, Uthis P. Factors related to methamphetamine relapse risk among clients in the substance rehabilitation center of National Narcotics Board in West Java, Indonesia. Journal of Health Research. 2018;32(4):279-87. Nikmanesh Z, Baluchi MH, Motlagh AAP. The role of self-efficacy beliefs and social support on prediction of addiction relapse. Int J High Risk Behav Addict. 2017;6(1):e21209. Zhang Y, Feng B, Geng W, Owens L, Xi J. “Overconfidence” versus “helplessness”: A qualitative study on abstinence self-efficacy of drug users in a male compulsory drug detention center in China. Substance Abuse Treatment, Prevention, and Policy. 2016;11:1-13. Ahmadi Jouybari T, Zakiei A, Salemi S, Lak Z, Mohebian M, Castaldelli-Maia JM, et al. Clustering of methamphetamine users based on personality characteristics and self-efficacy in the west of Iran. Scientific Reports. 2024;14(1):15826. Schuck K, Otten R, Kleinjan M, Bricker JB, Engels RC. Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation. Drug and Alcohol Dependence. 2014;142:269-76. Hiemstra M, Otten R, Engels RC. Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time survival analysis. Journal of behavioral medicine. 2012;35:240-51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6846491","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500676995,"identity":"dd9d979a-01ad-4a44-b5b5-050df84cd5fa","order_by":0,"name":"Sahel Kanjouri","email":"","orcid":"","institution":"Islamic azad university","correspondingAuthor":false,"prefix":"","firstName":"Sahel","middleName":"","lastName":"Kanjouri","suffix":""},{"id":500676998,"identity":"456e32af-d910-4a9d-96cf-776e119d7189","order_by":1,"name":"Mehdi Merati","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mehdi","middleName":"","lastName":"Merati","suffix":""},{"id":500676999,"identity":"c87a0700-cea6-4beb-aa8f-acbba9883cf2","order_by":2,"name":"Maryam Khanegi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBACAwYeBsbGBoSAHAOQf4AkLcZALQ2kaUkEsfFqMWc/e/DjzB12eQbXDj/7zFOzLX1+2GGgLTU20bi0WPbkJUtuPJNcbHA7zXg2z7HbuRtvJwK1HEvLbcChxeBAjoHkwzbmxA23E4yZediAWmYDtTA2HMat5fwb458P2+qBWtI/M/P8u51uSFDLjRwzyY1th4FacoyZedtuJ8hLE9BiOeNdmuXMtuOJM2/nFDPO7bttuAGkJQGPX8z5cw/f7G2rTuy7nb6Z4c232/Lys9MfPvhQY4NTCxwoHGBgYOIBBwiQSCCkHATkgYYy/oAyRsEoGAWjYBQgAwAYKWzZniHB7QAAAABJRU5ErkJggg==","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Khanegi","suffix":""}],"badges":[],"createdAt":"2025-06-08 09:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6846491/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6846491/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95797991,"identity":"1c1000eb-5202-4c45-9d6d-109c116aa663","added_by":"auto","created_at":"2025-11-13 08:13:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":550887,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6846491/v1/3186fc19-a9e5-4317-9630-10e00fc8b862.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship between Self-Compassion and Self-Efficacy in Predicting Relapse Risk among Methamphetamine Users","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSubstance Use Disorder (SUD), as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), is a maladaptive pattern of substance use leading to significant psychological distress or functional impairment(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2022, an estimated 292\u0026nbsp;million people\u0026mdash;5.6% of the global population aged 15\u0026ndash;64 engaged in illicit drug use, marking a 20% increase from a decade ago(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Iran, SUD affects approximately 2.8\u0026nbsp;million individuals, with regions like Kermanshah facing particularly high rates of substance use and addiction-related mortality, posing substantial public health challenges (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe repercussions of SUD extend beyond individuals, disrupting family dynamics, straining social systems, and burdening healthcare infrastructures(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite its increasing prevalence and complexity, current interventions often fall short, particularly in identifying psychosocial risk factors and enhancing long-term treatment adherence(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). As the global burden of SUD is projected to rise, there is a growing consensus on the necessity of patient-centered and individualized therapeutic models.\u003c/p\u003e\u003cp\u003eRelapse and psychological vulnerabilities relapse, defined as the return to substance use following a period of abstinence, occurs in approximately 40\u0026ndash;60% of patients within the first year post-treatment(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This process typically unfolds across emotional, mental, and behavioral dimensions and is frequently precipitated by psychological vulnerabilities such as impaired emotion regulation and diminished self-efficacy(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). While considerable research has focused on pharmacological and behavioral treatments, less attention has been paid to the interplay of psychological strengths that may buffer against relapse(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRole of self-Compassion and self-Efficacy among these strengths, self-compassion\u0026mdash;characterized by self-kindness, mindfulness, and a sense of shared humanity\u0026mdash;has shown promise as an adaptive emotion regulation strategy associated with greater psychological resilience and reduced engagement in high-risk behaviors(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similarly, self-efficacy, or an individual\u0026rsquo;s belief in their capacity to manage challenges, has consistently emerged as a robust predictor of sustained abstinence(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, limited empirical work has examined their combined predictive value, particularly in high-risk populations.\u003c/p\u003e\u003cp\u003eThe present study seeks to address this gap by investigating whether higher levels of self-compassion and self-efficacy are associated with reduced risk of relapse in individuals with SUD residing in Kermanshah, a region with elevated rates of substance use and addiction-related mortality(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Using a longitudinal design with a six-month follow-up, this research aims to inform targeted psychosocial interventions and support the development of more effective relapse prevention strategies.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cb\u003eDesign and setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis cross-sectional study was conducted at the Farabi Center, a psychiatric health hospital affiliated with Kermanshah University of Medical Sciences (KUMS). As the primary psychological institution in western Iran, Farabi Hospital provides advanced psychological services. The study employed a convenience sampling method, involving 105 individuals diagnosed with SUD. The Ethics Committee of KUMS approved the study, ensuring adherence to human rights, ethical standards, and safety throughout all procedures. All participants provided written informed consent prior to assessment. (Ethics code: IR.KUMS.MED.REC.1401.2). Clinical trial number: not applicable. To ensure confidentiality, participants completed questionnaires in a private conference room, with each session lasting approximately 30 minutes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample Size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was determined based on a pilot study, using a 95% confidence level and a 5% margin of error. According to the Cochrane table for sample size determination, a minimum of 84 participants was required. Accounting for a potential 25% dropout rate, a sample size of 105 were deemed appropriate.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInclusion criteria included a diagnosis of opioid use disorder, willingness to participate and complete questionnaires, ability to understand the study procedures, and provision of informed consent. Exclusion criteria included non-cooperation in completing questionnaires, severe mental health conditions impairing accurate responses, chronic psychiatric disorders, and significant medical conditions affecting cognitive function, history of brain injuries, intellectual disability, pregnancy, or unwillingness to participate.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssessment tools\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSelf-Compassion Scale\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe Self-Compassion Scale, a 26-item self-report questionnaire, assessed self-compassion at three time points(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Participants rated items (e.g., \u0026ldquo;I try to be understanding and patient toward aspects of my personality I don\u0026rsquo;t like\u0026rdquo;) on a 5-point Likert scale from \u0026ldquo;Almost Never\u0026rdquo; to \u0026ldquo;Almost Always,\u0026rdquo; with higher scores indicating greater self-compassion. The SCS includes six subscales assessing three bipolar facets: self-kindness versus self-judgment, mindfulness versus over-identification, and common humanity versus isolation. The SCS demonstrated good reliability and validity in this study, with internal consistency ranging from α\u0026thinsp;=\u0026thinsp;0.87 to 0.90(\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eThe General Self-Efficacy Scale\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe General Self-Efficacy Scale, developed by Schwarzer and Jerusalem, has been translated into 28 languages(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This questionnaire uses a 5-point Likert scale, with items 1, 2, 3, 6, 13, and 15 scored from \u0026ldquo;completely disagree\u0026rdquo; (0) to \u0026ldquo;completely agree\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and other items reverse-scored. Total scores range from 17 to 85, categorized as low (\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), moderate (35\u0026ndash;51), or high (above 51) self-efficacy.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRelapse risk Questionnaire\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe Substance Abuse Relapse Risk Questionnaire, developed by Ogai et al. (2007) and subsequently validated by Wright (2018), comprises 35 closed-ended items rated on a 5-point Likert scale from \u0026ldquo;completely disagree\u0026rdquo; (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) to \u0026ldquo;completely agree\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The questionnaire includes five subscales evaluating different aspects of substance use: anxiety and intention to consume (eight items), emotional problems (eight items), compulsion to consume (four items), positive expectations and lack of control over consumption (six items), and lack of negative expectations from the substance (four items). Additionally, it features a lie detection scale with five items to assess individuals\u0026rsquo; insight into their substance abuse issues. Total scores range from 35 to 175, with scores between 35 and 70 indicating a low relapse risk, 70 to 140 indicating a moderate risk, and above 140 indicating a high risk (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSocio-demographic information\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eSocio-demographic information including age, gender, and marital status, history of smoking and alcohol use, and economic characteristics (including family income, house ownership, and living status).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe Statistical Package for the Social Sciences (SPSS) (ver. 23.0) was used for the purpose of data entry, manipulation, and analysis. Quantitative variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026micro;\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), and qualitative/categorical ones as frequencies and percentages. Bivariate Pearson correlation coefficient was utilized to ascertain the magnitude, and direction of the associations between the relapse with the Self-Compassion and Self-Efficacy. Linear regression analysis (stepwise method) was performed to explain the variation of the relapse, based on the Self-Compassion, Self-Efficacy, and demographic variable.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTheir mean age was 36.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.72 (\u0026micro;\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) years. A of 95 participants (91.3%) were male and 26.9% had primary education. Most participants (56.6%) were married .In addition, 61.5% had a history of drug abuse Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Sociodemographic, economical, and clinical information of participants (n\u0026thinsp;=\u0026thinsp;105).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eRelapse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40(38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106.37(16.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.554\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(28.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102.60(17.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026lt;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(32.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106.85(16.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (19.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.347\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95(91.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e113 (80.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39(39.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97 (69.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.778\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(56.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (30.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced-widow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.50(13.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHouse ownership\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTenant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66(64.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104.58 (16.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.327\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLandlords\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(35.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107.97 (16.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(61.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105.46 (16.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.980\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40(38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105.37 (17.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(26.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104.21 (20.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.545\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school and diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44(42.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107.54 (14.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(30.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103.51 (16.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean of risk of relapse, self-compassion and general self-efficacy is 105.43\u0026thinsp;\u0026plusmn;\u0026thinsp;16.92, 2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 and 47.52\u0026thinsp;\u0026plusmn;\u0026thinsp;11.11 respectively Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Frequency distribution of drug relapse risk levels, self-compassion and self-efficacy among patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003emean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003elevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eRisk of relapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e105.43(16.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (3.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eintermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99(95.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ehigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSelf-compassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.90(0.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(1.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eintermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102(98.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ehigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGeneral self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e47.52(11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21(21.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eintermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71(68.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ehigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(10.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAccording to\u003c/b\u003e Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e which shows the bivariate Pearson correlation between predictor variables (the distress tolerance and resilience) and criterion variable (relapse) which were most of them, statistically significant at either 0.01 level. For example, the distress tolerance was associated with the resilience (r\u0026thinsp;=\u0026thinsp;0.975). Additionally, the distress tolerance (r = -0.693) and resilience (r = -0.725) were significantly related to the relapse.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Correlation between different components.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eRisk of relapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.382**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.520**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0001\u0026gt;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0001\u0026gt;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSelf-compassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.514**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0001\u0026gt;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGeneral self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Correlation is significant at the 0.05 level (2-tailed).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e** Correlation is significant at the 0.01 level (2-tailed).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates that the self-efficacy was able to explain 27.3% of the variation of the relapse. Likewise, there was a negative and significant relationship between the resilience and relapse (Beta=-0.441 and P\u0026thinsp;=\u0026thinsp;4.442** (\u0026lt;\u0026thinsp;0.0001)).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictors of the relapse\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandardized Coefficients Beta\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-compassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-1.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-4.442**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eR square\u0026thinsp;=\u0026thinsp;0.536, Adjusted R square\u0026thinsp;=\u0026thinsp;0.273, F\u0026thinsp;=\u0026thinsp;19.97, P-value\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the psychological factors influencing relapse risk among methamphetamine users treated at Farabi Hospital in Kermanshah, Iran. Our findings reveal significant inverse relationships between self-compassion, self-efficacy, and the likelihood of relapse. These results align with prior research highlighting the role of emotional and cognitive factors in addiction recovery\u003c/p\u003e\u003cp\u003eOver recent decades, addiction has been increasingly recognized as a manifestation of psychological distress. Research has focused on variables such as emotional regulation, attachment styles, and self-soothing capacities. While individual vulnerabilities are critical, external factors like family dynamics and cultural norms also significantly influence addiction and recovery processes(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). For instance, Giannouli and Ivanova (2019) found that demographic characteristics, such as age, gender, and education, were not strong predictors of coping strategies among cannabis users, suggesting that addiction mechanisms extend beyond superficial traits (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Instead, interpersonal relationships, environmental stressors, and societal expectations interact with internal processes to shape substance use behaviors. Thus, SUDs are deeply influenced by external factors, including familial relationships, societal norms, and environmental stressors.\u003c/p\u003e\u003cp\u003eAmong internal protective factors, self-compassion has emerged as pivotal in fostering emotional resilience. Unlike traditional coping mechanisms that primarily suppress symptoms, self-compassion addresses emotional underpinnings of substance use, such as shame, guilt, and self-criticism(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Relational experiences, particularly within families and romantic partnerships, may influence self-compassion development, indirectly affecting relapse risk. Our findings show that individuals with higher self-compassion exhibit healthier emotional responses and reduced vulnerability to relapse. However, research specifically examining self-compassion and SUDs remains limited (\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Recent studies have begun to address this gap. For instance, Shreffler et al. (2022) found that self-compassion is associated with personal growth and well-being in individuals with SUD, including those with methamphetamine use disorder.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Similarly, Carlyle et al. (2019) demonstrated that brief compassion-focused therapy reduces SUD risk by fostering self-compassion, emphasizing interventions targeting self-criticism and promoting non-judgmental acceptance (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn parallel, our research also identified self-efficacy as a significant protective factor. Individuals with higher self-efficacy beliefs were less prone to relapse, aligning with findings from Nikmanesh et al. (2017) and Hendianti (2018) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Zhang et al. (2016) reported that low self-efficacy is associated with more frequent relapses and a tendency to view relapse as personal failure(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Recent research has further explored self-efficacy in methamphetamine users. Ahmadi Jouybari et al. (2024) clustered methamphetamine users based on personality traits and self-efficacy, finding that different clusters had varying levels of mental health, sleep quality, and relapse risk, highlighting the importance of self-efficacy in recovery(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eAdditionally, Schuck et al. (2014) illustrated the efficacy of enhancing self-efficacy in preventing smoking relapse during high-risk situations, reinforcing that high self-efficacy equips individuals to resist temptations, reducing relapse likelihood (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). These findings reinforce the idea that self-efficacy, as a personality trait, plays a crucial role in influencing substance use relapse. Individuals with high self-efficacy are better equipped to resist temptations, thereby reducing their likelihood of relapse(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study provides compelling evidence for the protective roles of self-compassion and self-efficacy in reducing relapse risk among methamphetamine users. These findings contribute to the existing literature and suggest avenues for developing targeted psychosocial interventions that enhance these psychological strengths to support sustained recovery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile this study provides valuable insights into the role of self-compassion and self-efficacy in relapse prevention among methamphetamine users, it is essential to acknowledge several limitations that may influence the interpretation of the findings. First, the cross-sectional design of the study precludes establishing causal relationships between these psychological factors and relapse risk. Although associations were observed, it remains unclear whether self-compassion and self-efficacy directly influence relapse or if other variables mediate these relationships. Longitudinal studies are necessary to clarify the temporal and causal dynamics of these associations.\u003c/p\u003e\u003cp\u003eSecond, the sample was limited to individuals receiving treatment at Farabi Hospital in Kermanshah, which may restrict the generalizability of the results. The unique cultural, socioeconomic, and treatment contexts of this region might not be representative of other populations with substance use disorders. Therefore, replicating this research in diverse settings and with varied demographics would enhance the external validity of the findings.\u003c/p\u003e\u003cp\u003eThird, the study relied on self-reported measures to assess self-compassion, self-efficacy, and relapse risk. Self-report data are susceptible to biases, such as social desirability and recall inaccuracies, which could affect the accuracy of the results. Incorporating objective measures, such as behavioral observations or physiological indicators, would provide a more robust evaluation of these constructs.\u003c/p\u003e\u003cp\u003eLastly, while self-compassion and self-efficacy were identified as protective factors, the underlying mechanisms through which they exert their effects remain underexplored. Future research integrating neurobiological assessments, such as neuroimaging, could elucidate the neural correlates of these psychological processes in the context of addiction recovery.\u003c/p\u003e\u003cp\u003eTo address these limitations, future studies should aim to:\u003c/p\u003e\u003cp\u003eReplicate the findings in larger, more diverse samples to enhance generalizability.\u003c/p\u003e\u003cp\u003eEmploy longitudinal and experimental designs to establish causal relationships between self-compassion, self-efficacy, and relapse risk.\u003c/p\u003e\u003cp\u003eUtilize multi-method approaches, including objective measures, to validate self-reported data.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study underscores the transformative potential of self-compassion and self-efficacy as protective factors in mitigating relapse risk among individuals with methamphetamine use disorder. By fostering acceptance and resilience in the face of challenging emotions, self-compassion interventions offer a promising pathway to sustained recovery, addressing the emotional underpinnings of addiction, such as shame and self-criticism. Similarly, strengthening self-efficacy equips individuals to resist the temptations of substance use, enhancing their capacity to navigate high-risk situations with confidence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval\u0026nbsp;and consent to participate\u003c/p\u003e\n\u003cp\u003eThe ethical committee of the KUMS (Kermanshah University of medical sciences) approved the study protocol (ethics code IR.KUMS.MED.REC.1401.2). All participating provided written informed consent for participating in this study. The text of written informed consent was explained to illiterate individuals, if they were satisfied, the consent form was received. This study was performed in accordance with relevant guidelines and regulations in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo\u0026nbsp;funding\u0026nbsp;to declare.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMKh, MM, SK: Conception or design of the work; MM: Data collection; MKh: Data analysis and interpretation; MKh, MM, SK: Drafting the article, Critical revision of the article, and Final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eIn this way, the authors would like to express their deepest gratitude and appreciation to Kermanshah University of medical sciences (KUMS), and all participants in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCrone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, et al. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders. American Journal of Psychiatry. 2023;180(2):167-71.\u003c/li\u003e\n\u003cli\u003eHeikkil\u0026auml; H, Maalouf W, Campello G. The United Nations Office on Drugs and Crime\u0026rsquo;s efforts to strengthen a culture of prevention in low-and middle-income countries. Prevention Science. 2021;22(1):18-28.\u003c/li\u003e\n\u003cli\u003eKnox C, Wilson M, Klinger CM, Franklin M, Oler E, Wilson A, et al. DrugBank 6.0: the DrugBank knowledgebase for 2024. Nucleic acids research. 2024;52(D1):D1265-D75.\u003c/li\u003e\n\u003cli\u003eShahbazi F, Mirtorabi D, Ghadirzadeh MR, Hashemi-Nazari SS. Analysis of mortality rate of illicit substance abuse and its trend in five years in Iran, 2014-2018. Addiction \u0026amp; health. 2018;10(4):260.\u003c/li\u003e\n\u003cli\u003eDiagnostic A. statistical manual of mental disorders. Washington, DC: American 7 Psychiatric Association. Text revision. 2000;8.\u003c/li\u003e\n\u003cli\u003eFirst MB, Yousif LH, Clarke DE, Wang PS, Gogtay N, Appelbaum PS. DSM‐5‐TR: Overview of what\u0026rsquo;s new and what\u0026rsquo;s changed. World Psychiatry. 2022;21(2):218.\u003c/li\u003e\n\u003cli\u003eCostello MJ, Li Y, Remers S, MacKillop J, Sousa S, Ropp C, et al. Effects of 12-step mutual support and professional outpatient services on short-term substance use outcomes among adults who received inpatient treatment. Addictive Behaviors. 2019;98:106055.\u003c/li\u003e\n\u003cli\u003eMelemis SM. Relapse and relapse prevention. Alcohol use: assessment, withdrawal management, treatment and therapy: ethical practice: Springer; 2023. p. 349-61.\u003c/li\u003e\n\u003cli\u003eSchulenberg J, Johnston L, O\u0026apos;Malley P, Bachman J, Miech R, Patrick M. Monitoring the Future national survey results on drug use, 1975-2019: Volume II, college students and adults ages 19-60. 2020.\u003c/li\u003e\n\u003cli\u003eMehmandoost S, Mirzazadeh A, Karamouzian M, Khezri M, Sharafi H, Shahesmaeili A, et al. Injection cessation and relapse to injection and the associated factors among people who inject drugs in Iran: The Rostam study. Substance Abuse Treatment, Prevention, and Policy. 2023;18(1):72.\u003c/li\u003e\n\u003cli\u003eNeff KD. Self-compassion: Theory, method, research, and intervention. Annual review of psychology. 2023;74(1):193-218.\u003c/li\u003e\n\u003cli\u003eLitt MD, Kadden RM, Tennen H, Dunn HK. Momentary coping and marijuana use in treated adults: Exploring mechanisms of treatment. Journal of consulting and clinical psychology. 2021;89(4):264.\u003c/li\u003e\n\u003cli\u003eKarakasidou E, Pezirkianidis C, Galanakis M, Stalikas A. Validity, reliability and factorial structure of the Self Compassion Scale in the Greek population. Journal of Psychology and Psychotherapy. 2017;7(313):2161-0487.\u003c/li\u003e\n\u003cli\u003eNeff KD. The development and validation of a scale to measure self-compassion. Self and identity. 2003;2(3):223-50.\u003c/li\u003e\n\u003cli\u003eBasharpoor S. Psychometric properties of the persian version of the self compassion scale in university students. 2014.\u003c/li\u003e\n\u003cli\u003eNeff KD, T\u0026oacute;th-Kir\u0026aacute;ly I, Yarnell LM, Arimitsu K, Castilho P, Ghorbani N, et al. Examining the factor structure of the Self-Compassion Scale in 20 diverse samples: Support for use of a total score and six subscale scores. Psychological assessment. 2019;31(1):27.\u003c/li\u003e\n\u003cli\u003eWilliams MJ, Dalgleish T, Karl A, Kuyken W. Examining the factor structures of the five facet mindfulness questionnaire and the self-compassion scale. Psychological assessment. 2014;26(2):407.\u003c/li\u003e\n\u003cli\u003eSherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The self-efficacy scale: Construction and validation. Psychological reports. 1982;51(2):663-71.\u003c/li\u003e\n\u003cli\u003eWright AJ. Comprehensive assessment of substance abuse and addiction risk in adolescence. New Directions in Treatment, Education, and Outreach for Mental Health and Addiction. 2018:25-55.\u003c/li\u003e\n\u003cli\u003eOgai Y, Haraguchi A, Kondo A, Ishibashi Y, Umeno M, Kikumoto H, et al. Development and validation of the Stimulant Relapse Risk Scale for drug abusers in Japan. Drug and alcohol dependence. 2007;88(2-3):174-81.\u003c/li\u003e\n\u003cli\u003eHarris MT, Laks J, Stahl N, Bagley SM, Saia K, Wechsberg WM. Gender dynamics in substance use and treatment: A women\u0026rsquo;s focused approach. The Medical Clinics of North America. 2022;106(1):219.\u003c/li\u003e\n\u003cli\u003eFairbairn CE, Briley DA, Kang D, Fraley RC, Hankin BL, Ariss T. A meta-analysis of longitudinal associations between substance use and interpersonal attachment security. Psychological bulletin. 2018;144(5):532.\u003c/li\u003e\n\u003cli\u003eRodriguez LM, Derrick J. Breakthroughs in understanding addiction and close relationships. Current opinion in psychology. 2017;13:115-9.\u003c/li\u003e\n\u003cli\u003eGiannouli V, Ivanova D, editors. Perceived parents\u0026apos; and partners\u0026apos; attitudes towards female women with alcohol dependence: do they really matter? EUROPEAN PSYCHIATRY; 2019: ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER 65 RUE CAMILLE \u0026hellip;.\u003c/li\u003e\n\u003cli\u003eGermer C, Neff K. Teaching the mindful self-compassion program: A guide for professionals: Guilford Publications; 2019.\u003c/li\u003e\n\u003cli\u003eLeary MR, Tate EB, Adams CE, Batts Allen A, Hancock J. Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Journal of personality and social psychology. 2007;92(5):887.\u003c/li\u003e\n\u003cli\u003eNeff K. Self-compassion and psychological well-being. Constructivism in the human sciences. 2004;9(2):27.\u003c/li\u003e\n\u003cli\u003eGraham C. Examining the role of self-compassion in acceptance and commitment therapy with a substance abusing population: Spalding University; 2016.\u003c/li\u003e\n\u003cli\u003eShreffler J, Thomas JJ, McGee S, Ferguson B, Kelley J, Cales R, et al. Self-compassion in individuals with substance use disorder: the association with personal growth and well-being. Journal of addictive diseases. 2022;40(3):366-72.\u003c/li\u003e\n\u003cli\u003eCarlyle M, Rockliff H, Edwards R, Ene C, Karl A, Marsh B, et al. Investigating the feasibility of brief compassion focused therapy in individuals in treatment for opioid use disorder. Substance Abuse: Research and Treatment. 2019;13:1178221819836726.\u003c/li\u003e\n\u003cli\u003eHendianti GN, Uthis P. Factors related to methamphetamine relapse risk among clients in the substance rehabilitation center of National Narcotics Board in West Java, Indonesia. Journal of Health Research. 2018;32(4):279-87.\u003c/li\u003e\n\u003cli\u003eNikmanesh Z, Baluchi MH, Motlagh AAP. The role of self-efficacy beliefs and social support on prediction of addiction relapse. Int J High Risk Behav Addict. 2017;6(1):e21209.\u003c/li\u003e\n\u003cli\u003eZhang Y, Feng B, Geng W, Owens L, Xi J. \u0026ldquo;Overconfidence\u0026rdquo; versus \u0026ldquo;helplessness\u0026rdquo;: A qualitative study on abstinence self-efficacy of drug users in a male compulsory drug detention center in China. Substance Abuse Treatment, Prevention, and Policy. 2016;11:1-13.\u003c/li\u003e\n\u003cli\u003eAhmadi Jouybari T, Zakiei A, Salemi S, Lak Z, Mohebian M, Castaldelli-Maia JM, et al. Clustering of methamphetamine users based on personality characteristics and self-efficacy in the west of Iran. Scientific Reports. 2024;14(1):15826.\u003c/li\u003e\n\u003cli\u003eSchuck K, Otten R, Kleinjan M, Bricker JB, Engels RC. Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation. Drug and Alcohol Dependence. 2014;142:269-76.\u003c/li\u003e\n\u003cli\u003eHiemstra M, Otten R, Engels RC. Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time survival analysis. Journal of behavioral medicine. 2012;35:240-51.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Self-compassion, substance use disorders, self-efficacy, relapse risk","lastPublishedDoi":"10.21203/rs.3.rs-6846491/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6846491/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Substance Use Disorder (SUD) is a complex social phenomenon that continues to rise across diverse human societies, despite growing knowledge and awareness of its consequences. Psychological factors can diminish the effectiveness of opioid withdrawal interventions. Therefore, this study was conducted to assess the effects of self-compassion and self-efficacy on relapse rates among methamphetamine users over a one-year follow-up period in Kermanshah, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This cross-sectional study involved 105 patients (mean age = 36.00, SD = 10.72) diagnosed with SUD, randomly selected from those admitted to the Farabi Psychological Center in Kermanshah in 2023. Data were collected using the Self-Compassion Scale, General Self-Efficacy Scale, Substance Abuse Risk Questionnaire, and a demographic questionnaire. Collected data were analyzed using Pearson correlation and multivariate regression with SPSS 18.0 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e The average age of the patients was 36.00 ± 10.72 and 95 (91.3%) patients were male. The findings of the research showed that the total self-compassion score of the participants was 2.90± 0.31.The self-efficacy score of the subjects was 47.52 ±11.11 on average, and the levels of both variables were low in most patients. The scores obtained from responding to the risk of substance abuse relapse questionnaire were on average 105.43 ±16.92 and most people had an average level of relapse risk. Among the studied variables, the relationship of self-compassion and self-efficacy with drug relapse was highly significant and inverse (p\u0026lt;0.001). The self-efficacy variable with a standard regression coefficient of -0.441 has been the most important in explaining the variance of the risk of drug relapse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Based on the findings regarding the impact of self-compassion training on reducing craving and enhancing self-efficacy in patients with methamphetamine dependence, we recommend integrating self-compassion skills training into drug rehabilitation centers and hospital wards to complement conventional therapies.\u003c/p\u003e","manuscriptTitle":"The Relationship between Self-Compassion and Self-Efficacy in Predicting Relapse Risk among Methamphetamine Users","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 08:18:50","doi":"10.21203/rs.3.rs-6846491/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"faaa24ec-ae53-4a57-bcf3-260a0b7b5fdf","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T11:54:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-20 08:18:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6846491","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6846491","identity":"rs-6846491","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}