A study on the effects of addiction level, stress, and social support of drug relapse patients on changes in motivation of quiting substance misuse behaviors

Abstract

Objective

To understand the influencing factors of withdrawal motivation among drug Addictions during the period of forced withdrawal, reveal the mediating role of drug addiction level and stress perception in the relationship between social support and withdrawal motivation changes among drug Addictions, and further improve the theoretical system of compulsory drug withdrawal.

Method

Based on extensive literature review, this study adopts a cross-sectional survey design. A structured questionnaire design was adopted to conduct a comprehensive survey on the basic information, degree of addiction, perceived stress, social support, and MQSMB. Descriptive analysis, correlation analysis, stepwise regression analysis, and structural equation modeling were used to process the obtained database.

Results

1) The standardized regression coefficient β indicates that among the background factors affecting the Changes In MQSMB, gender is the most important (β = 0.142*), marriage is the second most important (β = -0.127*), and active addiction cessation experience is the smallest (β = 0.117*); 2) Stepwise regression analysis showed that personal background, addiction level, social support, and perceived stress had predictive powers of 14.2%, 9.1%, 5.5%, and 7.7%, respectively, for changes in MQSMB; 3) Social support can significantly reduce the addiction level and stress perception of drug addicts. The degree of addiction not only plays an mediating role in the change of social support and MQSMB, but also assumes a chain mediating role through the combination of stress perception.

Conclusion

In order to enhance the MQSMB, reduce relapse rates, and increase social support, it is crucial to adjust stress response appropriately and reduce psychological dependence on medication.

addict.

Introduction

In recent years, the abuse of illegal drugs, alcohol addiction, and other substances, as well as the resulting social problems, have become a highly valued policy focus in countries around the world. The reason is that once substance abuse addiction behavior is formed, it has a high recurrence rate, is difficult to deal with, and is prone to interruption during the treatment period [1]. According to the 2023 annual report of the United Nations Office on Drugs and Crime, the global drug user population was approximately 296 million in the past year, accounting for 5.8% of the global population aged 15–64, which is equivalent to one in every 17 people, an increase of 23% compared to ten years ago; However, only one-fifth of cases receive professional assistance, with women developing substance addiction at a faster rate than men, and their proportion receiving treatment in drug rehabilitation centers is significantly lower [2]. More than 85% of drug addicted patients in the United States will use addictive substances again within a year [3], and even if these patients have undergone mandatory isolation, the proportion of those who give up halfway is still high. Among the 42 communities in the United States that tracked first-time opium addicts, only 28% were able to complete a complete recovery [4].

At present, there are about 2.4 million registered drug users in China, of which more than half are relapse patients who have failed to quit drugs. Methamphetamine has replaced heroin as the most abused drug in China. Although the social harm of drug use has been reduced, the risk of affecting public safety still exists [5]. In fact, the National Institute on Drug Abuse (NIDA) in the United States recommends that research on drug addiction rehabilitation treatment should be expanded to more fields, especially in measuring the Severity of drug addiction, stress status, psychosocial function, motivation of quiting substance misuse behaviors (MQSMB), quality of life, and the effectiveness of social support [6].

In the face of drug addiction, the United States mainly adopts voluntary drug rehabilitation methods. The treatment options include outpatient, inpatient, and residential institutions [7, 8], among which the most distinctive residential institution model is the therapeutic community (TC), whose main purpose is to help drug addictions return to society. At present, the main drug rehabilitation model in China is"mandatory isolation drug rehabilitation", which was established in 2008. Through the establishment of distinctive"education and rehabilitation centers"throughout the country, a national unified judicial and administrative drug rehabilitation work model is based on phased zoning, supported by professional centers, centered on scientific drug rehabilitation, and extended by linkage assistance [9, 10]. In order to de label, individuals who undergo mandatory isolation and drug rehabilitation are referred to as"patients"or"brain disease patients". Drug addictions entering the correctional facility need to undergo 2–3 years of mandatory isolation and rehabilitation to assist them in quitting their addiction and returning to society.

Literature review

Changes In MQSMB

The transition from addiction to successful quitting is a long process of change, and the change in motivation for quitting refers to a dynamic state of behavior, cognition, and emotion during the process of quitting addiction. According to the differences in motivation patterns, it can be divided into different stages of change patterns: Preconception (PC), Context (C), Preparation (P), Action (A), Maintenance (M), Relapse (R), etc. These patterns exhibit characteristics of phased processes [11]. The MQSMB can be understood through the process of changing stages, and the six stages can also be seen as a continuous aspect of change readiness.

Research suggests that drug addiction is not solely caused by physiological factors, but rather by numerous causes and significant environmental influences. Addictive behavior occurs in a social environment, and the social environment in which drug addictions exist provides multiple dangerous or protective factors that dynamically affect drug addiction behavior [12, 13]. Among the many factors contributing to drug addiction, age, education level, socioeconomic status, family structure, social status, drug awareness, personality traits, and others are common major factors [14]. Drug abusers who are unemployed, have a lower age of initial drug use, and have a higher number of years of drug abuse tend to have a higher craving for medication [15]. Factors such as gender, age, education level, and duration of drug use also affect the effectiveness of drug addiction treatment, and age and age of initial heroin use are related to relapse after drug addiction [16]. The study also found that the higher the degree of drug addiction, the higher the MQSMB. In terms of participation in various addiction treatment processes, those who completed addiction treatment performed better, and women performed better than men. There were significant gender differences in motivation to change addiction [16, 17].

The impact of stress on the MQSMB

The compulsory rehabilitation center provides detoxification treatment to drug addictions in a restricted freedom detention environment. Research has found that the greatest stress experienced by individuals undergoing compulsory abstinence is reflected in their daily routines and regulations, as well as issues with their family background. In the early stages of compulsory abstinence, stress levels include internal routines, family problems, interpersonal problems, economic problems, environmental limitations, and the deprivation of freedom and autonomy [18]. Therefore, the environment of a compulsory abstinence center can create various pressures on drug addictions, affecting their adaptation to life in the center and ultimately impacting their motivation and behavior to quit. Related studies have found that stress from parents and families can affect the inability of drug addictions to quit, and the stress state can effectively predict whether they will interrupt their addiction [19].

Generally, stressful situations are high-risk for drug addiction relapse. When stress occurs, if the drug addiction lacks good stress coping skills, the likelihood of relapse will increase. Research on stress and stress coping has found that when drug addictions quit, facing drugs, tools, or environmental stimuli related to the use of illegal drugs can trigger anxiety or depression, and also affect their motivation and actions to continue quitting [20]. From the perspective of addiction characteristics, drug addiction is considered to be a three-stage cycle of poisoning, withdrawal and negative effects, and pre occupation and expectation, which causes physiological damage and social relationship damage; From a neurobiological perspective, it has been found that negative emotions, stress, and drug craving are related, indicating that stress may be the cause and recurrence of drug addiction. Predictable and unpredictable stressors may have different effects on the MQSMB [21]. In short, stress can have a physical and mental impact on drug addictions, especially on the functioning of the brain, affecting their cognitive function and control ability, as well as triggering thirst and increasing the risk of relapse. Therefore, when considering drug addiction patterns, social context must be included to understand the relationship between stress and individual behavior. Stress can affect the MQSMB, but there is still no definitive view in academia on whether it leads to an increase or decrease in motivation.

The impact of social support on MQSMB

On the other hand, social support has a significant positive effect on changing addiction and can promote MQSMB. Research has found that social support is the interpersonal determinant of successful addiction cessation. The better the social support, the more sustained the addiction can be. Social support can make drug addictions willing to continue treatment and increase treatment effectiveness [22]; Social support can predict the MQSMB and assist in quitting behavior, as drug addictions require strong MQSMB during the withdrawal period, and social support factors are important variables that enhance their MQSMB [23, 24]. In fact, it is very important to assist drug addictions in establishing a social support system, especially the family members, close friends, work partners, rehabilitation peers, helpers, and some self-help rehabilitation groups that are all components of this support system. Especially from family support, it is one of the important factors for drug addictions to quit addiction, because the stress adjustment and social support of drug addictions can help them rehabilitation [25]. At the same time, family is an important support for successful drug rehabilitation, which can affect the willingness of drug addictions to follow social norms [26]. After drug addictions return to society, the support from their families helps them adapt to life and lay the foundation for trying to quit addiction [27].

In summary, craving for drugs, compulsive use, and relapse are important characteristics of drug addictions, and changes in MQSMB are one of the important factors affecting addiction. Generally, stress can decrease the motivation of addictions and hinder their recovery from addiction [13]. However, making good use of pressure from family, work, or the judiciary may significantly improve the completion rate and success rate of addictions in implementing addiction programs [28]. Family support is related to the intention of drug addiction relapse, and the better the family support, the lower the intention of drug addiction relapse [23]. However, the Changes In MQSMB is a dynamic process that requires different assistance and coping strategies at different stages. However, there is currently a lack of complete theoretical and practical responses to this changing process both domestically and internationally. Therefore, this study aims to use empirical data to explore the relevant factors that affect the motivation of drug addictions to quit during the rehabilitation period. By establishing corresponding rehabilitation models, the relationship between these variables can be revealed, and the key factors that affect the MQSMB can be identified.

Research objectives and hypotheses

The purpose of this study is to explore the factors related to Changes In MQSMB during the rehabilitation period through survey data. Through multiple regression analysis and structural equation modeling, the following hypotheses are verified: 1) Reveal the predictive power of variables such as gender, age, age of initial drug use, marital relationship, education level, active withdrawal seeking professional treatment experience, drug addiction level, perceived stress during withdrawal period, social support during withdrawal period, and expected post withdrawal social support on their MQSMB; 2) Explore the impact and pathways of Social Support, Severity of Drug Addiction, and Perceived Pressure on Changes In MQSMB, and further reveal the mediating role of Severity of Drug Addiction and Perceived Pressure.

Research objects and methods

Respondents

The Chongqing Sports Drug Rehabilitation Research Center has two bases, the Chongqing Xishanping Education and Correctional Center (currently with about 2000 students under compulsory rehabilitation) and the Chongqing Nan'an District Women's Education and Correctional Center (currently with about 1500 Substance Abusers under compulsory rehabilitation). From November 2023 to March 2024, researchers would consult with the leaders of two bases to determine the list of drug addictions (at least those who have entered the compulsory rehabilitation center for isolation and drug rehabilitation for the second time) through screening and investigation. Before officially filling out the questionnaire, research participants need to sign a research consent form.

Determine the sample size based on n = P (1-P)/[E²/Z² + P (1-P)/N]. The error of this study is within plus or minus 0.05, and the survey results are within a 95% confidence range. The 95% confidence level requires a Z statistic of 1.96, an estimated P of 0.5, and a population of 1000 units. The sample size is: n = 0.5 * 0.5/(0.05 * 0.05/(1.96*1.96) + 0.5*0.5/1000) = 278. Therefore, A total of 500 questionnaires were distributed to two compulsory isolation drug rehabilitation centers, and 350 valid questionnaires were collected. This fully meets the minimum sample size requirement.

Ethics approval and consent to participate

This study has been approved by the Ethics Committee of Southwest University (approval number: SWU-ETH-2024–03–15–001) and conducted in accordance with the ethical standards set forth in the 1964 Helsinki Declaration. All participants voluntarily participated in this experiment and signed informed consent forms prior to the study.

Research tool

Table 1 shows:

Table 1.

Validity and reliability testing of four measurement scales

Scale Name/KMO and Bartlett Ball Test	Dimension Naming	Mean score	Item	eigenvalue	Variation%	Progressive variation%	Cronbach α coefficient
Drug Addiction Scale/KMO = 0.89; P = 0.000	Tolerant withdrawal	9.68 ± 3.89	6	8.74	25.1	25.1	0.81
	Relationship damage	14.69 ± 8.05	7	6.11	17.5	42.6	0.77
	Social function damage	10.87 ± 4.59	5	4.86	13.9	56.5	0.71
	Physiological damage	12.45 ± 5.14	6	3.74	10.7	67.2	0.79
Measurement model validation results: AGFI = 0.91、CFI = 0.94、NFI = 0.93、IFI = 0.90、RMSEA = 0.031; Overall scale, Cronbach ɑ = 0.78
Pressure Perception Scale/KMO = 0.89; P = 0.000	Work and economic pressure	17.32 ± 4.48	7	15.32	32.6	32.6	0.85
	Family and life pressures	13.15 ± 3.47	6	10.20	21.7	54.3	0.82
	Interpersonal and Recurrent Stress	12.44 ± 4.09	5	5.69	12.1	66.4	0.87
Measurement model validation results: AGFI = 0.94、CFI = 0.92、NFI = 0.91、IFI = 0.96、RMSEA = 0.044; Overall scale, Cronbach ɑ = 0.84
Social Support Scale/KMO = 0.89; P = 0.000	Emotional or evaluative support	12.06 ± 2.78	4	18.57	25.4	25.4	0.77
	Instrumental or substantive support	12.87 ± 3.21	4	13.56	18.5	43.9	0.78
	Companionship or belongingness support	11.94 ± 2.58	4	10.87	14.9	58.8	0.86
	Maintaining self-esteem	11.52 ± 3.26	4	6.58	9.0	67.8	0.81
Measurement model validation results: AGFI = 0.93、CFI = 0.92、NFI = 0.95、IFI = 0.91、RMSEA = 0.039; Overall scale, Cronbach ɑ = 0.80
MQSMB Scale/KMO = 0.89; P = 0.000	Confusion period (PC)	48.26 ± 4.25	8	15.24	21.56	21.6	0.78
	Contemplation period (C)	52.36 ± 3.14	8	11.27	15.9	37.5	0.85
	Action period (A)	48.26 ± 4.25	8	8.87	12.5	50.0	0.81
	Maintenance period (M)	52.36 ± 5.14	8	6.19	8.6	58.6	0.83
	Motivation change score	8.24 ± 2.59	32	—	—	—	—

Measurement model validation results: AGFI = 0.94、CFI = 0.91、NFI = 0.90、IFI = 0.92、RMSEA = 0.036; Overall scale, Cronbach ɑ = 0.82

A structured design method was used to construct the questionnaire, which consists of five parts: background information of drug addictions, drug addiction level scale, social support scale, stress perception scale, and addiction motivation change scale.

1. Background information of drug addictions. There are a total of 6 pieces of information: gender, age, age of first use of medication, marriage, education level, and experience in actively seeking professional treatment for addiction.

2. Measurement of drug addiction level. Adopting an improved version of the Drug Abuse Screening Test (DAST) [29], it is mainly used to evaluate subjects'drug dependence, physiological symptoms after medication, negative emotions caused by medication, and social adaptation problems arising from medication. The scale consists of 24 questions, divided into four dimensions: tolerance withdrawal, relationship damage, social function damage, and physiological damage. Participants are asked about their medication experience in the 12 months prior to entering the correctional facility. This scale adopts the Likert five-point scoring method and scores 0–1–2–3–4 according to"never, rarely, sometimes, often, always".

3. Pressure sensing measurement. The stress perception scale developed by Lijuan and Xianren (2005) was used [30], which consists of two parts: stress perception during the period of strong abstinence (14 questions) and stress perception after leaving the drug rehabilitation center (18 questions). This study chose the second part. Post employment stress perception can be divided into three dimensions: work and economic pressure, family and life adaptation pressure, and interpersonal relationship and relapse pressure. Using the Likert five-point scoring method, score 0–1–2–3–4 points based on"never before, almost never, sometimes, often, always". Negative questions are scored in reverse. The higher the score, the higher the perceived pressure.

4. Social support measurement. Using the social support scale developed by Ban et al., which contains 40 questions [31],. This scale also measures from two aspects. The social support obtained within the correctional facility (24 questions) and the expected social support after leaving the facility (16 questions). This study chooses the second part for evaluation, which consists of four dimensions: emotional or evaluative support, instrumental or substantive support, companionship or belonging support, and self-esteem maintenance. Using the Likert five-point scoring method, score 0–4 points based on"never, rarely, sometimes, often, always".

5. MQSMB Scale. This study used the Change Assessment Scale developed by Dicemente et al. [11]. This scale is mainly used to evaluate the clinical course of various addictive behaviors and the degree of motivation to prepare for change, in order to understand whether research participants are ready to change their problematic behaviors. The problem behaviors in the original scale refer to various types of behaviors that individuals want to change, such as smoking, drinking, drug use, etc. The original scale consists of 32 questions, and the scoring method adopts the Likert five-point scoring method. The scoring method is based on 1–5 points for strongly disagree, disagree, disagree, agree, and strongly agree.

   The total scale consists of four change stage subscales, including the confusion period (PC), contemplation period (C), action period (A), and maintenance period (M), with 8 questions per subscale. This scale can calculate the motivation change score of addictions, and the calculation method is as follows: motivation change score = C/7 + A/7 + M/7 ‒ PC/7. Scores can be used for regression prediction, with higher scores indicating greater support for changing attitudes or behaviors in the respondents.

6. Validity and reliability. From the perspective of internal consistency of the scales, the Cronbach's alpha values of drug addiction level (4 dimensions), stress perception (3 dimensions), social support (4 dimensions), and change in addiction motivation (4 dimensions) are 0.78 (0.81, 0.77, 0.71, 0.79), 0.84 (0.85, 0.82, 0.87), 0.80 (0.77, 0.78, 0.86, 0.81), and 0.82 (0.78, 0.85, 0.81, 0.83), respectively, indicating good measurement reliability of the four scales; From the perspective of exploratory factor analysis and measurement model testing, the progressive explanatory power of the common factors in the four scales reached 67.2%, 66.4%, 67.8%, and 586%, respectively. The AGFI, CFI, NFI, IFI, and RMSEA values all reached the optimal range, indicating good measurement validity of the four scales.

Statistical methods

This study used SPSS21.0 and AMOS 19.0 to perform statistical analysis on the data, including normality test, descriptive analysis, correlation analysis, and regression analysis. When conducting chain mediation analysis, Bootstrap method was used, and the original data was sampled 2000 times to estimate the 95% confidence interval (CI) [32]. Firstly, if the indirect effect does not include 0 within the 95% confidence interval and reaches a significant level, it indicates that there is a mediating effect. At this point, if the direct effect includes 0 within the 95% confidence interval, it indicates that the direct effect is not significant and is a complete mediating effect; If both indirect and direct effects do not include 0 within the 95% confidence interval and reach a significant level, and the total effect does not include 0 within the 95% confidence interval and reaches a significant level, then it is a partial mediation effect. The significance level of all variables is α = 0.05.

Results

Population background and variable description of research participants

Table 2 shows that the proportion of male and female participants in this study was 61.7% and 39.3%, respectively. The highest proportion was among those with an average age of 25.8 years (62.8%), followed by those aged 31–40 years (25.4%); The average age of initial drug use is 21.6 years old; In terms of marital status, married individuals account for 35.2%, while others (such as single, divorced, widowed, etc.) make up the majority (64.8%); The education level is mainly dominated by junior high school (41.7%) and high school (33.4%), with the vast majority of participants not actively seeking professional treatment for addiction (78.6%).

Table 2.

Statistical table of participant population background variables analysis (N = 350)

Variable Name	Classification	frequency (%)	Mean
Gender	Male	216 (61.7)	—
	Female	134 (39.3)	—
Age	20 years old and under	20 (5.6)	18.5 ± 3.7
	21–30 years old	220 (62.8)	25.8 ± 4.1
	31–40 years old	89 (25.4)	36.1 ± 3.3
	41 years old and above	21 (6.2)	47.2 ± 8.7
Initial medication age	—	—	21.6 ± 5.9
Marriage	Married	123 (35.2)	—
	Other	227 (64.8)	—
Educational level	Elementary school and below	54 (15.5)	—
	junior high school	146(41.7)	—
	High school (including vocational school)	117(33.4)	—
	College degree or above	33(9.4)	—
Active addiction cessation experience	Once there was	75(21.4)	—
	Never before	275(78.6)	—

The relationship between variables affecting the MQSMB

Table 3 shows:

Table 3.

The correlation between 9 independent variables of the subjects and changes in MQSMB

Variable Name	01	02	03	04	05	06	07	08	09	10
01 Gender	1.00
02 Age	−0.148**	1.00
03 Initial medication age	−0.054	0.671**	1.00
04 Marriage	0.132**	0.012*	0.124*	1.00
05 Educational level	0.028	−0.201**	−0.126*	0.033	1.00
06 Active addiction cessation experience	0.041	0.074	−0.094	0.081	−0.041	1.00
07 Severity of drug addiction	0.005	0.047	0.065	0.005	0.127*	0.356**	1.00
08 Perceived pressure	−0.044	0.020	0.009	−0.123*	−0.062	0.133*	0.412**	1.00
09 Social support	0.087	−0.115*	−0.047	0.066	0.225**	−0.061	−0.187**	−0.477**	1.00
10 Changes In MQSMB	−0.184**	−0.034	0.064	−0.134*	0.087	0.251**	0.411**	0.184**	0.564**	1.00

*/**/*** represent significant levels of 0.05, 0.01, and 0.001, respectively

1. The 9 variables significantly correlated with changes in MQSMB include gender (r = −0.184*), marriage (r = −0.134*), active quitting experience (r = 0.251**), addiction severity (r = 0.411**), perceived stress after discharge (r = 0.184**), and social support after discharge (r = 0.564**);

2. Age, age of first use of medication, education level, and other factors are almost unrelated to motivation changes to quit addiction; The severity of drug addiction is significantly positively correlated with education level (r = 0.127*) and active abstinence experience (r = 0.356**), while perceived stress after leaving the workplace is negatively correlated with marriage (r = −0.123*), but positively correlated with active abstinence experience (r = 0.133*).

3. Social support after leaving the institution is negatively correlated with the severity of addiction (r = −0.187**) and perceived stress after leaving the institution (r = −0.477**), while the Severity of drug addiction is significantly positively correlated with perceived stress after leaving the institution (r = 0.412**).

Analysis of factors influencing changes in MQSMB

Table 4 shows:

Table 4.

Regression analysis of changes in MQSMB with 8 independent variables of subjects

	Model I		Model II		Model III		Model IV
	β	95%CI	β	95%CI	β	95%CI	β	95%CI
Gender (Baseline = Female)	0.142**	0.006 ~ 0.215	0.145**	0.027 ~ 0.206	0.136*	0.069 ~ 0.201	0.144**	0.062 ~ 0.203
Age	0.051	0.006 ~ 0.124	0.044	0.006 ~ 0.102	0.031	0.006 ~ 0.085	0.043	0.006 ~ 0.088
Initial medication age	0.037	0.003 ~ 0.098	0.027	0.005 ~ 0.054	0.011	0.001 ~ 0.046	0.027	0.003 ~ 0.054
Marriage (Baseline = Other Situation)	−0.127**	−0.205 ~ −0.001	−0.129**	−0.214 ~ −0.058	−0.116*	−0.251 ~ −0.055	−0.129*	−0.241 ~ −0.082
Educational level	−0.022	−0.087 ~ −0.007	−0.021	−0.115 ~ −0.008	−0.032	−0.003 ~ −0.062	−0.044	−0.007 ~ −0.069
Active addiction cessation experience	0.117*	0.015 ~ 0.214	0.121*	0.102 ~ 0.219	0.133*	0.056 ~ 0.213	0.125*	0.087 ~ 0.189
Severity of drug addiction			0.327**	0..210 ~ 0.452	0.314**	0.214 ~ 0.405	0.350**	0.201 ~ 0.412
Perceived pressure					0.184**	0.095 ~ 0.263	0.211**	0.125 ~ 0.369
Social support							0.301**	0.217 ~ 0.411
F/P	11.02**		13.54***		12.78***		16.77/***
R2	0.142		0.233		0.287		0.364
▲R2			0.091		0.054		0.077

*/**/*** represent significant levels of 0.05, 0.01, and 0.001, respectively

1. In Model I, six control variables were introduced, including gender, age, age of initial medication use, marriage, education level, and experience of actively quitting addiction. Education level, marital status, and work status were transformed into dummy variables and regression analysis was conducted. The results showed that the regression equation was very significant (F = 11.02, P < 0.01, R² = 0.142), Three predictive variables reached a significant level, with the highest to lowest predictive power being gender (β = 0.142**), marriage β = −0.127**), and active withdrawal experience β = 0.117*. Except for marriage, which had a negative relationship, the other two variables had a positive relationship with changes in withdrawal motivation; The total variance explained by the impact of the six predictor variables on the dependent variable, addiction motivation, is 14.2%.

2. Model II added drug addiction severity (F = 13.54, P < 0.001, R² = 0.233) on the basis of Model I, Model III added post employment stress perception (F = 12.78, P < 0.001, R² = 0.287) on the basis of Model II, and Model IV added post employment social support (F = 16.77, P < 0.001, R² = 0.364) on the basis of Model III. Similarly, Models II, III, and IV all reached very significant levels, with corresponding ▲R² values of 0.091, 0.054, and 0.077, indicating that the three predictive variables of addiction severity, post employment stress perception, and post employment social support had an impact on changes in addiction motivation of 9.1%, 5.5%, and 7.7%, respectively.

Path analysis of addiction severity, perceived stress, and social support on changes in MQSMB

The results from Fig. 1 indicate that the absolute adaptation index X² of the model is 28.25, X²/df = 2.17, P = 0.081 > 0.05, Explain that the covariance matrix of the assumed model is compatible with the observed data; Value added adaptation index GFI = 0.933, AGFI = 0.914, RMSEA = 0.056, NFI = 0.921, IFI = 0.932, CFI = 0.941, RFI = 0.932。 It can be seen that the initial association pattern of this study, after modification, is well adapted to the actual data.

Fig. 1.

The impact pathways of addiction level, stress, and social support on changes in MQSMB

As shown in Fig. 1 and combined with Table 5:

Table 5.

Analysis of the mediating effect of drug addiction degree and perceived stress as social support and changes in MQSMB

Mediation Model I: Social Support → Severity of drug addiction → Changes In MQSMB			Mediation Model III: Social Support → Perceived Stress → Changes In MQSMB
	Predictive power%	95% CI		Predictive power%	95% CI
Indirect effects: social support → Severity of drug addiction → Changes In MQSMB	−0.06*	−0.121 ~ −0.001	Indirect effect: Social support → Perceived stress → Changes In MQSMB	−0.10*	−0.154 ~ −0.008
Direct effect: Social support → Changes In MQSMB	0.26**	0.314 ~ 0.681	Direct effect: Social support → Changes In MQSMB	0.26**	0.314 ~ 0.681
Total effect: Social support → Changes In MQSMB	0.20**	0.151 ~ 0.362	Total effect: Social support → Changes In MQSMB	0.16**	0.101 ~ 0.269
Mediation Model II: Social Support → Drug Addiction → Perceived Stress			Mediation Model IV: Severity of drug addiction → Perceived Stress → Changes In MQSMB
Indirect effects: social support → Severity of drug addiction → perceived stress	−0.07*	−0.139 ~ 0.003	Indirect effect: Severity of drug addiction → perceived stress → Changes In MQSMB	0.07*	0.006 ~ 0.157
Direct effect: Social support → Perceived stress	−0.12**	−0.205 ~ −0.005	Direct effect: Severity of drug addiction → Changes In MQSMB	0.03*	0.058 ~ 0.124
Total effect: Social support → Perceived stress	−0.19**	−0.288 ~ −0.025	Total effect: Severity of drug addiction → Changes In MQSMB	0.10*	0.008 ~ 0.126

Chain Effect V: Social Support → Severity of drug addiction → Perceived Stress → Changes In MQSMB; Standard effect quantity = 0.033, 95% CI:0.001 ~ 0.119

*/**represent significant levels of 0.05 and 0.01, respectively

1. Intermediary Path I: Social Support → Severity of drug addiction → Change in Detoxification Motivation. The indirect effect of social support on the change of MQSMB is −0.06 * (−0.31 × 0.18), which is very significant, with a confidence interval of −0.1212 to −0.001, obviously not including zero. The direct effect of social support on the change of MQSMB is 0.26**, which is very significant, with a confidence interval of 0.314 to 0.681, obviously not including zero. At the same time, the total effect (direct effect + indirect effect) is 0.20**, with a confidence interval of 0.151 to 0.362, also not including zero. This fully confirms that the Severity of drug addiction plays a partial mediating role between social support and the change of MQSMB.

2. Intermediary Path II: Social Support → Severity of drug addiction → Perceived Stress. The indirect effect of social support on stress perception is −0.07 * (−0.31 × 0.23), which is very significant, with a confidence interval of −0.139 to 0.003, obviously not including zero. The direct effect of social support on stress perception is −0.12*, which is very significant, with a confidence interval of −0.205 to −0.005, obviously not including zero. At the same time, the total effect (direct effect + indirect effect) is −0.19**, with a confidence interval of −0.288 to −0.025, also not including zero. This fully confirms that drug addiction plays a partial mediating role between social support and stress perception.

3. Intermediary pathway III: Social support → Perceived stress → Changes In MQSMB. The indirect effect of social support on the Changes In MQSMB through stress perception is −0.10* (−0.35 × 0.29), which is very significant, with a confidence interval of −0.154 to −0.008, obviously not including zero. The total effect of social support on the Changes In MQSMB through stress perception (direct + indirect) is 0.16**, with a confidence interval of 0.101 to 0.269, also not including zero. Therefore, it can be concluded that stress perception plays a partial mediating role between family socioeconomic status and group effect addiction motivation change.

4. Intermediary pathway IV: Drug addiction level → Perceived stress → Changes In MQSMB. The indirect effect of drug addiction level on the Changes In MQSMB through stress perception is 0.07* (0.23 × 0.29), which is very significant, with a confidence interval of 0.006–0.157, obviously not including zero. The direct effect of drug addiction level on the Changes In MQSMB is 0.18*, which is very significant, with a confidence interval of 0.058–0.124, obviously not including zero. At the same time, the total effect (direct effect + indirect effect) is 0.10*, with a confidence interval of 0.008–0.126, also not including zero. This fully confirms that stress perception plays a partial mediating role between drug addiction level and the Changes In MQSMB.

5. Chain mediation V: The influence of social support on the Changes In MQSMB: Direct influence (0.53 × 0.53 = 0.28) + Indirect influence of social support on the Changes In MQSMB through the Severity of drug addiction (−0.31 × 0.18 = −0.06) + Indirect influence of social support on the Changes In MQSMB through pressure perception (−0.35 × 0.29 = −0.10) + Social support → Severity of drug addiction → chain influence of pressure perception on the Changes In MQSMB (−0.31 × 0.23 × 0.29 = −0.02). It can be seen that social support has a total impact of 10.0% on Changes In MQSMB.

Discussions

The influence of social background of drug addictions on changes in MQSMB

Previous studies have shown that there is no significant relationship between age of first use of medication and changes in MQSMB [33, 34], which is consistent with the results of this study. However, there are also studies indicating that the education level and age of first use of drugs of substance abusers are related to their relapse after quitting addiction [35]. In terms of gender, previous studies have also pointed out that the older male drug addictions are, the higher the recurrence rate [35, 36]. Some studies have also suggested that gender is not related to the recurrence rate or changes in addiction motivation [34]. However, this study also found that gender is related to changes in addiction motivation, as women have higher MQSMB. This may be due to the fact that female drug addictions'drug use factors are more related to their emotional partners [37, 38]. After entering a strong rehabilitation center, their influence from their emotional partners decreases, and they will have more mental and time to perceive the consequences of drug use, resulting in higher motivation for female drug addictions to quit. This study found that.

From the perspective of the marital status of drug addictions, previous research results have also been inconsistent. Some studies have shown that marriage is not related to changes in addiction motivation [39], while others suggest that marriage is related to relapse rates [35]. Scholars have also found [40] that unmarried individuals are significantly positively correlated with relapse rates, while married individuals are significantly negatively correlated with relapse rates. In this study, it was found that marriage can predict changes in addiction motivation, and unmarried individuals have higher rates of relapse motivation. In terms of seeking professional treatment experience for active addiction cessation, previous studies have found [41] that individuals with active addiction cessation experience are more likely to be aware of their drug addiction problems and the harm it can cause them. Therefore, they have a higher motivation to seek changes in addiction cessation. WenJu & LiChen found [42] that participants in addiction rehabilitation programs can improve their mental health and quality of life regardless of whether they complete the entire treatment plan. This experience will also provide encouragement and support for their participation in addiction rehabilitation programs. Due to the fact that those who have actively quit their addiction have already realized that their drug addiction has caused harm to themselves, their motivation to seek a change in addiction is higher.

The impact of addiction stress on changes in MQSMB

Generally, the stress factors faced by substance abuse individuals participating in compulsory isolation and drug rehabilitation come from two aspects, namely the perceived stress during the rehabilitation period in the rehabilitation center and the expected stress they will face after leaving the center. Both types of stress may affect the motivation to quit addiction and change. Based on the objective of this study, which is to achieve social regression for substance addicts, the perceived stress during the abstinence period was not considered, and only the expected stress after withdrawal was measured. Koob and Schulkin pointed out that [43] stress can affect the functioning of the motivational reward system in an individual's brain, which in turn affects the brain and triggers drug addiction behavior. Kaye et al. investigated rodent addiction models by manipulating predictable and unpredictable stress, and found that unpredictable stress plays an important role in the etiology and recurrence of addiction. The perception or prediction of stress can affect the MQSMB [20].

This study evaluates expected stress from three dimensions: expected work and economic stress, expected family and life stress, and expected interpersonal and relapse stress, representing the three different sources of stress that substance abusers expect themselves to face after leaving the rehabilitation center. Previous studies have found that social situations can induce individuals'vulnerability to coping stress and affect the patterns of drug addiction behavior [44]. Amaro et al. pointed out that social stressors can trigger individuals'vulnerability to drug addiction behavior [45]. This study found a positive correlation between expected stress and MQSMB (r = 0.184**), and from the overall effect of expected stress on MQSMB, it is highly correlated with changes in addiction motivation, and it alone has a predictive power of 5.4% for MQSMB. This is consistent with previous research findings, which suggest that social situations can induce individuals'vulnerability to stress coping and affect changes in addiction behavior [46]. Therefore, in order to promote a change in MQSMB, family members, social volunteers, business leaders, and judicial departments should work together to assist and reduce the sources of stress for substance abusers, which is one of the key factors for successfully quitting addiction.

The impact of social support on changes in MQSMB

Social support refers to the emotional and tangible assistance provided by others and perceived as useful by the recipient [47]. Research has shown that positive social support (such as family relationships, community, relevant institutions, etc.) is crucial for helping drug addicts eliminate or delay relapse behavior. The increase in relapse frequency among drug addicts is related to a decrease in perceived social support and a decrease in overall social support [48]. Social support can strongly predict drug relapse tendencies (among drug addicts in rehabilitation centers) and awareness of serving society (among family and friends around them after leaving rehabilitation centers) [49]. This study used a partial scale of expected social support after graduation, which consists of four dimensions: emotional or evaluative support, instrumental or substantive support, companionship or belonging support, and self-esteem maintenance.

The structural model clearly shows that the impact of social support on the Changes In MQSMB may have a dual effect through the mediation of drug addiction level and the chain mediation of drug addiction level and stress perception. This study further confirms that social support can significantly predict perceived stress. Due to the fact that changes in drug rehabilitation motivation are an important indicator for predicting relapse behavior, indicating the likelihood and willingness of individuals to engage in relapse behavior, it is a necessary prerequisite for individuals to develop specific behaviors [50]. The higher the tendency to relapse, the greater the likelihood of relapse behavior. Relapse can be attributed to both internal and external factors, including mental illness (anxiety/neuroticism), withdrawal symptoms, cognitive impairment, unemployment, flawed coping strategies, interpersonal conflicts, social stress, lack of support, stigmatization, sleep patterns, lack of leisure activities and treatment facilities, etc. [51]. This study found that social support has a direct impact of 28.0% on changes in addiction motivation, but social support has an indirect negative impact of 6.0% on changes in addiction motivation through the degree of drug addiction. Social support has an indirect negative impact of 10.0% on changes in addiction motivation through pressure perception. Social support has a chain negative impact of 2.0% on changes in addiction motivation through → degree of drug addiction → pressure perception, indicating that the total positive impact of social support on changes in addiction motivation is only 10.0%. It can be seen that social support is crucial for changing the motivation of drug addictions. Only by exerting the positive effect of social support and weakening or suppressing its negative effect can it be more conducive to reducing the relapse rate of drug addictions and ultimately achieving social rehabilitation. From the perspective of criminology, some scholars believe that social support may not always have a beneficial impact on drug users [52]. Because social support is of great significance to the stress perception of drug addictions, in addition to employment support and community integration support, dignity and care seem to be more important for them [53]. Because the self-esteem of drug addictions is significantly lower than that of the general population, drug use can bring feelings of guilt or self hatred to users, which can damage their self-esteem and self-image [54].

In this study, the social support obtained by drug addictions after returning to the community is classified into four dimensions: emotional or evaluative support, instrumental or substantive support, companionship or belonging support, and maintenance of self-esteem. Multiple regression analysis shows that overall social support has a predictive power of 9.1% for changes in addiction motivation, which is close to the contribution power (10.0%) in structural equation modeling. This is due to the fact that the addiction motivation change score in regression analysis is calculated from C/7 + A/7 + M/7-PC/7. According to the research report by Shaghaghi et al. [55], the emotional atmosphere perceived by individuals in their family and school can significantly predict their readiness to quit addiction; Carrico et al. found [56] that specific social support related to addiction cessation can help predict the outcome of drug addiction treatment, and the higher the level of such social support, the better the outcome of drug addiction treatment. Therefore, if these social supports can be understood and applied in practice during treatment, timely assistance can be provided to drug addictions to increase their connection with social support, so that they can receive better family, peer, and social support, which can effectively prevent drug addictions from relapsing [57].

Research limitations

4.1 This study evaluates the drug addiction level of individuals who abuse substances from four aspects: tolerance withdrawal, relationship damage, social function damage, and physiological damage. However, in the specific analysis, only the overall drug addiction level of the subjects was analyzed, and the correlation between the four different representations in the addiction process and the MQSMB was not explored in depth. In the future, this issue can be further discussed in depth;

4.2 This study did not evaluate the perceived stress of substance abusers during the rehabilitation period, which includes two dimensions: loss of control and exhaustion response. The former refers to the feeling of losing control, while the latter refers to the psychological state of physical and mental exhaustion and exhaustion. The impact of perceived stress during rehabilitation on the MQSMB deserves further exploration in the future;

4.3 This study only explored the overall impact of expected stress on MQSMB, without delving into the relationships between expected work and economic stress, expected family and life stress, expected interpersonal and relapse stress, and MQSMB. Expected interpersonal and relapse stress are social stressors, and whether their impact on MQSMB is unique requires further in-depth exploration in the future;

4.4 This study used cross-sectional research data, and a longitudinal cohort design can be used to detect causal relationships between variables in the future; Individuals who abuse substances all come from two strong rehabilitation centers, and the universality of their research results needs to be further confirmed by expanding the sample size;

4.5 In this study, social support measurement only selected the expected social support portion, and the analysis process only explored the overall social support. There was no in-depth analysis of its four dimensions, namely emotional or evaluative support, instrumental or substantive support, companionship or belonging support, and self-esteem maintenance. Further exploration is needed in the future.

Conclusion

1. There is a negative correlation between marriage, perceived stress after leaving the institution, and changes in MQSMB among drug addictions. This is manifested in women, unmarried individuals, those who have actively quit seeking professional treatment, those with high severity of drug addiction, high perceived stress after leaving the institution, and those with high social support after leaving the institution having higher MQSMB;

2. Social support is significantly positively correlated with changes in MQSMB, while it is significantly negatively correlated with the severity of addiction and perceived stress; Meanwhile, the severity of addiction and perceived stress are significantly positively correlated with changes in MQSMB;

3. To improve the motivation level for quitting addiction, it is necessary to increase social support and adjust their stress perception appropriately to reduce addiction, in order to reduce psychological dependence on drugs and ultimately lower relapse rates.

Abbreviations

MQSMB

Motivation of quiting substance misuse behaviors

NIDA

National Institute on Drug Abuse

TC

Therapeutic community

PC

Confusion period

C

Contemplation period

A

Action period

M

Maintenance period

R

Relapse period

DAST

Drug Abuse Screening Test

CI

Confidence interval

Authors’ contributions

Shiqi Liu: writing original draft and editing, data analysis. Tingran Zhang, Yi Yang, Kun Wang, Jiong Luo: conceptualization, resources, draft editing. Jiong Luo is the PI of this project.

S.Q. contributed to the conception or design of the paper and drafted the manuscript; J.L.,T.R., Y.Y., and k.w. contributed to the data collection, analysis, Fig. 1, or interpretation of this work. J.L. is also responsible for project management and providing financial support. All authors reviewed the manuscript.

Funding

Project supported by the National Social Science Fund of China (No.: 22BTY064).

Data availability

The data that support the findings of this study are available from Southwest university, but restrictions apply to the availability of these data, which were used under licence for the current study and so are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of southwest university.

Declarations

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.