Journal of health research in community

Introduction
Substance use disorder is considered one of the major challenges in mental health due to its chronic nature, high relapse rates, emotional dysregulation, and executive dysfunction. Contemporary process-based models of addiction suggest that deficits in emotion regulation play a key role in the maintenance of substance use and relapse cycles. Individuals with substance dependence often experience greater difficulty using adaptive emotion regulation strategies and managing negative affective states compared with non-clinical populations [1, 2] . Neuropsychological evidence also indicates that dysregulation in prefrontal–limbic circuitry is associated with heightened impulsivity, emotional reactivity, craving, and increased vulnerability to relapse [3]. 
In recent years, mindfulness-based interventions, particularly mindfulness-based relapse prevention (MBRP), have gained substantial attention in addiction treatment. By promoting nonjudgmental awareness, reducing automatic reactivity, and increasing emotional acceptance, MBRP has demonstrated effectiveness in reducing craving and improving psychological functioning among individuals with substance use disorders [4, 5]. Nevertheless, emerging evidence suggests that single-component interventions may not be sufficient for individuals with severe executive and cognitive impairments. Consequently, integrative interventions targeting cognitive, emotional, and behavioral processes simultaneously have been proposed as potentially more effective approaches [6, 7]. 
Accordingly, the present study aimed to investigate the effect of an integrative relapse prevention (IRP) package compared with MBRP on emotion regulation among individuals with substance dependence. The integrative intervention was developed based on a process-oriented framework and incorporated neuropsychological psychoeducation, cognitive restructuring, emotional processing, Gestalt-based techniques, and coping-skills training. 

Methods
This study employed a quasi-experimental design with a pretest, posttest, follow-up assessment, and a control group. The study population consisted of individuals with substance dependence who were referred to addiction treatment centers. Participants meeting the inclusion criteria were selected using convenience sampling and randomly assigned to one of three groups: integrative relapse prevention (IRP), mindfulness-based relapse prevention (MBRP), or a control group. 
The IRP intervention was implemented in eight weekly 90-minute sessions. The intervention components included psychoeducation regarding neurobiological mechanisms of addiction, cognitive-behavioral conceptualization of craving, identification and restructuring of dysfunctional cognitions, Gestalt empty-chair techniques, structured processing of emotionally significant experiences, guided emotional processing, coping-skills training, emotion regulation strategies, and development of a personalized relapse prevention plan. The MBRP group received treatment in accordance with standard MBRP protocols. 
Data were collected using the Emotion Regulation Questionnaire developed by Gross and John (2003), which assesses two dimensions: cognitive reappraisal and expressive suppression. Previous studies have demonstrated satisfactory psychometric properties of this instrument in Iranian samples. Data were analyzed using a repeated-measures analysis of variance (ANOVA) in SPSS software, version 26. 

Results
The findings of the mixed ANOVA indicated that both interventions significantly improved emotion regulation compared with the control group (P<0.05). Furthermore, participants in the IRP group demonstrated significantly greater improvements in emotion regulation than those who received MBRP. The observed effect sizes suggested substantial intervention effects on the outcome variable. However, these findings should be interpreted cautiously, as factors, such as the relatively homogeneous sample, limited sample size, and repeated-measures design may have contributed to the magnitude of the observed effects. 

Conclusion
The findings of the present study support the effectiveness of IRP interventions in improving emotion regulation among individuals with substance dependence. Compared with MBRP, the integrative intervention appeared to produce greater improvements, potentially because it simultaneously targeted the cognitive, emotional, and executive processes associated with vulnerability to relapse. 
Although the findings were interpreted within neuropsychological and process-based frameworks, the present study did not directly assess neural or biological markers. Therefore, explanations of the underlying neural mechanisms remain theoretical and require further investigation through longitudinal and neuropsychological research designs. 
Overall, the results suggest that integrative and multidimensional interventions may represent promising approaches for enhancing emotional functioning and reducing relapse vulnerability in individuals with substance use disorders. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Mohaghegh Ardabili (Code: IR.UMA.REC.1404.053). Written informed consent was obtained from all participants.

Funding
This research received no specific grant from any funding agency in the public, commercial, or non-profit sectors.

Authors contributions
 Data collection, conducting interviews, and coding procedures: Ali BeheshtiMotlagh;  Supervision: Mohammad Narimani; :Data analysis and writing: Sajjad Basharpoor;  All authors read and approved the final version of the manuscript.Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this study.

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