The pathways between abstinence self-efficacy, perceived social support and substance use craving.

Low abstinence self-efficacy, lack of social support, especially from family and friends, low self-esteem, feeling lonely, and lack of self-control have been considered as risk factors for substance use disorders, but the pathways of these risk factors on drug craving have not yet been determined. Therefore, the present study aimed to evaluate the association between abstinence self-efficacy and perceived social support on the one hand to drug craving in patients referred to substance use treatment centers on the other hand, with loneliness, self-control, and self-esteem as mediating variables. The present study is a descriptive-correlational modeling study. The statistical population of this study included all individuals with a history of substance use referring to substance use treatment centers in Mazandaran province. Of these, 249 individuals were selected using a random cluster sampling method. Data were collected using six validated questionnaires including a demographic part, and questions on substance abstinence self-efficacy e, perceived social support, substance craving, self-esteem, self-control, and loneliness. The data were analyzed using structural equation modeling (SEM) with a partial least squares (PLS) approach to evaluate the relationships between variables. Based on the findings of this study, self-efficacy for drug abstinence was significantly and negatively associated with loneliness (p < 0.001), significantly positively associated with self-esteem (p < 0.001), significantly negatively associated with drug craving (p < 0.001), but no significant association was found with self-control (P = 0.377). Loneliness also was significantly positively associated with drug craving (p < 0.001). On the other hand, perceived social perception was significantly positively associated with drug abstinence self-control (p < 0.001), significantly negatively correlated with loneliness (p < 0.05), and significantly positively correlated with self-control (p < 0.001). However, no significant associations were found between perceived social perception on the one hand and self-esteem (P = 0.891) and drug craving (P = 0.144) on the other one. Further, we found that self-control was not significantly associated with substance craving (P = 0.121). Self-esteem was significantly negatively associated with loneliness (p < 0.001). Finally, a significant and direct association was found with substance craving (p < 0.001), but not with self-control (p = 0.458). Our study revealed that abstinence self-efficacy, loneliness, and social perception play a key role in predicting drug craving and self-esteem. As such, interventions to reduce drug craving might focus on increasing abstinence self-efficacy and social support, reducing loneliness, improving self-esteem, and self-control.